Phenotypic Clusters Predict Outcomes in a Longitudinal Interstitial Lung Disease Cohort

Ayodeji Adegunsoye, Justin Oldham, Jonathan H. Chung, Steven M. Montner, Cathryn Lee, Leah J. Witt, Danielle Stahlbaum, Rene S. Bermea, Lena W. Chen, Scully Hsu, Aliya N. Husain, Imre Noth, Rekha Vij, Mary E. Strek, Matthew Churpek

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background: The current interstitial lung disease (ILD) classification has overlapping clinical presentations and outcomes. Cluster analysis modeling is a valuable tool in identifying distinct clinical phenotypes in heterogeneous diseases. However, this approach has yet to be implemented in ILD. Methods: Using cluster analysis, novel ILD phenotypes were identified among subjects from a longitudinal ILD cohort, and outcomes were stratified according to phenotypic clusters compared with subgroups according to current American Thoracic Society/European Respiratory Society ILD classification criteria. Results: Among subjects with complete data for baseline variables (N = 770), four clusters were identified. Cluster 1 (ie, younger white obese female subjects) had the highest baseline FVC and diffusion capacity of the lung for carbon monoxide (DLCO). Cluster 2 (ie, younger African-American female subjects with elevated antinuclear antibody titers) had the lowest baseline FVC. Cluster 3 (ie, elderly white male smokers with coexistent emphysema) had intermediate FVC and DLCO. Cluster 4 (ie, elderly white male smokers with severe honeycombing) had the lowest baseline DLCO. Compared with classification according to ILD subgroup, stratification according to phenotypic clusters was associated with significant differences in monthly FVC decline (Cluster 4, –0.30% vs Cluster 2, 0.01%; P <.0001). Stratification by using clusters also independently predicted progression-free survival (P <.001) and transplant-free survival (P <.001). Conclusions: Among adults with diverse chronic ILDs, cluster analysis using baseline characteristics identified four distinct clinical phenotypes that might better predict meaningful clinical outcomes than current ILD diagnostic criteria.

Original languageEnglish (US)
Pages (from-to)339-348
Number of pages10
JournalChest
Volume153
Issue number2
DOIs
StatePublished - Feb 1 2018

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Keywords

  • cluster
  • interstitial lung disease
  • mortality
  • phenotype
  • pulmonary fibrosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Adegunsoye, A., Oldham, J., Chung, J. H., Montner, S. M., Lee, C., Witt, L. J., Stahlbaum, D., Bermea, R. S., Chen, L. W., Hsu, S., Husain, A. N., Noth, I., Vij, R., Strek, M. E., & Churpek, M. (2018). Phenotypic Clusters Predict Outcomes in a Longitudinal Interstitial Lung Disease Cohort. Chest, 153(2), 339-348. https://doi.org/10.1016/j.chest.2017.09.026