Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, USA.
Ther Adv Respir Dis. 2024 Jan-Dec;18:17534666241275329. doi: 10.1177/17534666241275329.
A six-minute walk test (6MWT) is a reproducible, easily performed test, and is widely used to determine functional exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). However, there is currently a paucity of data on the clinical significance of baseline and serial 6-minute walk tests in patients with IPF, especially in Asian patients.
We aimed to investigate the clinical significance of serial 6MWT in patients with IPF, especially in Asian patients.
This is a single-center retrospective cohort study.
Clinical data of patients diagnosed with IPF at a tertiary center in Korea were retrospectively analyzed. IPF diagnosis was defined according to the clinical guidelines of the American Thoracic Society (ATS)/European Respiratory Society (ERS)/Japanese Respiratory Society/Latin American Thoracic Association.
There were 216 patients diagnosed with IPF from December 2012 to January 2022, of whom 198 had a baseline of 6MWT data. The mean age of the cohort was 66.9 ± 8.6, and 89% were male. The non-survivors showed significantly lower six-minute walk distance (6MWD), minimum saturation of peripheral oxygen (SpO) during 6MWT, forced vital capacity, and diffusing capacity of the lung for carbon monoxide than survivors at baseline. A multivariate Cox analysis demonstrated that lower minimum SpO was independently associated with increased mortality rates (Hazard ratio (HR): 1.081, 95% confidence interval (CI): 1.024-1.142, = 0.005). Higher mortality rates were also associated with echocardiographic-determined pulmonary hypertension (HR: 2.466, 95% CI: 1.149-5.296, = 0.021) at diagnosis. Among 144 patients with 6MWT results at 12 months, patients with a decline of 50 m or more in the 6MWD showed poorer overall survival than others (median survival: 45.0 months vs 58.0 months, < 0.001).
Baseline lower minimum SpO during 6MWT was an independent prognostic factor in patients with IPF, and a decline in 6MWD in serial follow-up was also associated with a poorer prognosis. These findings suggest that both baseline 6MWT and follow-up data are important in the prognostication of patients with IPF.
六分钟步行试验（6MWT）是一种可重复、易于进行的测试，广泛用于评估特发性肺纤维化（IPF）患者的功能运动能力。然而，目前关于 IPF 患者基线和系列 6MWT 的临床意义的数据很少，特别是在亚洲患者中。
我们旨在研究系列 6MWT 在 IPF 患者中的临床意义，特别是在亚洲患者中。
这是一项单中心回顾性队列研究。
回顾性分析韩国一家三级中心诊断为 IPF 的患者的临床数据。IPF 诊断根据美国胸科学会（ATS）/欧洲呼吸学会（ERS）/日本呼吸学会/拉丁美洲胸科协会的临床指南定义。
2012 年 12 月至 2022 年 1 月期间，共有 216 名患者被诊断为 IPF，其中 198 名患者有基线 6MWT 数据。队列的平均年龄为 66.9±8.6，89%为男性。与幸存者相比，非幸存者在基线时的六分钟步行距离（6MWD）、六分钟步行试验期间外周血氧饱和度最低（SpO）、用力肺活量和一氧化碳弥散量均显著降低。多变量 Cox 分析表明，较低的最低 SpO 与死亡率增加独立相关（风险比（HR）：1.081，95%置信区间（CI）：1.024-1.142，=0.005）。较高的死亡率也与诊断时超声心动图确定的肺动脉高压相关（HR：2.466，95%CI：1.149-5.296，=0.021）。在 144 名有 12 个月 6MWT 结果的患者中，6MWD 下降 50 米或更多的患者总体生存率较其他患者差（中位生存：45.0 个月 vs 58.0 个月，<0.001）。
基线 6MWT 时较低的最低 SpO 是 IPF 患者的独立预后因素，系列随访中 6MWD 的下降也与预后较差相关。这些发现表明，基线 6MWT 和随访数据在 IPF 患者的预后评估中都很重要。
