The prognostic value of cardiopulmonary exercise testing in interstitial lung disease: a systematic review

Shaney L Barratt*, Richard J Davis, Charles Sharp, John Pauling

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

Abstract

The heterogeneity of interstitial lung disease (ILD) results in prognostic uncertainty concerning end of life discussions and optimal timing for transplantation. Effective prognostic markers and prediction models are needed. Cardio-Pulmonary Exercise Testing (CPET) provides a comprehensive assessment of the physiological changes in the respiratory, cardiovascular, and musculoskeletal systems in a controlled laboratory environment. It has shown promise as a prognostic factor for other chronic respiratory conditions. We sought to evaluate the prognostic value of CPET in predicting outcomes in longitudinal studies of ILD .

Medline, Embase and Cochrane systematic review databases were used to identify studies reporting prognostic value of CPET in predicting outcomes in longitudinal studies of ILD. Study quality was assessed using the Quality in Prognosis Study risk of bias tool.

Thirteen studies were included that reported the prognostic value of CPET in ILD. All studies reported at least one CPET parameter predicting clinical outcomes in ILD; with survival being the principle outcome assessed. Maximum oxygen consumption, reduced ventilatory efficiency and exercise induced hypoxaemia were all reported to have prognostic value in ILD. Issues with study design (primarily due to inherent problems of retrospective studies, patient selection and presentation of numerous CPET parameters), insufficient adjustment for important confounders and inadequate statistical analyses limits the strength of conclusions that can be drawn at this stage.

There is insufficient evidence to confirm the value of CPET in facilitating ‘real-world’ clinical decisions in ILD. Additional prospective studies are required to validate the putative prognostic associations reported in previous studies in carefully phenotyped patient populations.
Original languageEnglish
JournalEuropean Respiratory Journal
Publication statusAccepted/In press - 22 Apr 2020

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