Introduction:
Progressive pulmonary fibrosis (PPF) drives mortality in interstitial lung disease (ILD). The e-Lung (Brainomix, Oxford, UK) weighted reticulovascular score (WRVS), a CT biomarker of pulmonary fibrosis, offers prognostic value.
Aims:
To determine the predictive value of WRVS for mortality in patients with ILD and its prognostic benefit when combined with established clinical predictors.
Methods:
We retrospectively evaluated ILD patients at University of Chicago (IRB#17-1617), and assessed WRVS on baseline HRCT, defining high-risk WRVS as ≥20%. PPF was classified per ATS multidomain criteria. Cox regression assessed WRVS, GAP-ILD score, and PPF as mortality predictors. Harrell’s c-statistic evaluated the impact of WRVS on model performance.
Results:
150 of 272 patients (55%) with serial HRCT imaging had PPF. Median WRVS was higher in PPF than non-PPF patients (16.8 vs. 13.7; P<0.001). In univariate Cox analysis, PPF conferred a mortality hazard ratio (HR) of 2.10 (95% CI:1.50–2.94, P<0.001), while GAP-ILD and high-risk WRVS scores had HRs of 1.43 (95% CI:1.28–1.59, P<0.001) and 2.90 (95% CI:2.11–3.98, P<0.001), respectively. Adjusting for GAP-ILD and PPF status, WRVS remained independently associated with mortality (HR:1.87, 95% CI:1.32–2.66, P<0.001). Inclusion of WRVS improved Harrell’s c-statistic for mortality prediction from 0.61 (PPF) to 0.67 (PPF + WRVS), and 0.71 (PPF + GAP-ILD + WRVS); P<0.001.
Conclusions:
WRVS is a robust, independent predictor of mortality in ILD, especially in PPF. Its inclusion improves risk models, enhancing patient stratification and guiding treatment decisions. These findings support WRVS as a valuable tool for personalized ILD care.
