New 6-Minute-Walking Test Parameter-Distance/Desaturation Index (DDI) Correctly Diagnoses Short-Term Response to Immunomodulatory Therapy in Hypersensitivity Pneumonitis

Katarzyna B Lewandowska; Małgorzata Sobiecka; Piotr W Boros; Małgorzata Dybowska; Inga Barańska; Małgorzata E Jędrych; Agata Gładzka; Witold Z Tomkowski; Monika Szturmowicz

doi:10.3390/diagnostics13061109

New 6-Minute-Walking Test Parameter-Distance/Desaturation Index (DDI) Correctly Diagnoses Short-Term Response to Immunomodulatory Therapy in Hypersensitivity Pneumonitis

Diagnostics (Basel). 2023 Mar 15;13(6):1109. doi: 10.3390/diagnostics13061109.

Authors

Katarzyna B Lewandowska¹, Małgorzata Sobiecka¹, Piotr W Boros², Małgorzata Dybowska¹, Inga Barańska³, Małgorzata E Jędrych¹, Agata Gładzka⁴, Witold Z Tomkowski¹, Monika Szturmowicz¹

Affiliations

¹ 1st Department of Lung Diseases, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland.
² Department of Respiratory Physiopathology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland.
³ Department of Radiology, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland.
⁴ Department of Respiratory Rehabilitation, National Research Institute of Tuberculosis and Lung Diseases, 01-138 Warsaw, Poland.

Abstract

The six-minute-walking test (6MWT) is an easy-to-perform, cheap and valuable tool to assess the physical performance of patients. It has been used as one of the endpoints in many clinical trials investigating treatment efficacy in pulmonary arterial hypertension and idiopathic pulmonary fibrosis. However, the utility of 6MWT in patients diagnosed with hypersensitivity pneumonitis (HP) is still under investigation. The aim of the present retrospective study was to assess the value of different 6MWT parameters, including the newly developed distance-desaturation index (DDI), to evaluate immunomodulatory treatment outcomes in HP patients.

Methods: 6MWT parameters (distance, initial saturation, final saturation, desaturation, distance-saturation product (DSP), and DDI) were analyzed at baseline and after 3 to 6 months of treatment with corticosteroids alone or in combination with azathioprine.

Results: 91 consecutive HP patients diagnosed and treated in a single pulmonary unit from 2005 to 2017 entered the study. There were 44 (48%) males and 52 (57%) patients with fibrotic HP (fHP). Sixty-three patients (69%) responded to treatment (responders) and 28 (31%) did not respond (non-responders). In the responders group, all parameters assessed during 6MWT significantly improved, whereas in non-responders, they worsened. Medians (95% CI) of best indices were post-treatment DDI/baseline DDI-1.67 (1.85-3.63) in responders versus 0.88 (0.7-1.73) in non-responders (p = 0.0001) and change in walking distance-51 m (36-72 m) in responders, versus 10.5 m (-61.2-27.9) in non-responders (p = 0.0056). The area under the curve (AUC) of receiver operating characteristics (ROC) for post-treatment DDI/baseline DDI was 0.74 and the optimal cut-off was 1.075, with 71% of specificity and 71% of sensitivity.

Conclusions: 6MWT may be used as a tool to assess and monitor the response to immunomodulatory therapy in HP patients, especially if indices incorporating both distance and desaturation are used. Based on the present study results, we recommend 6MWD and DDI use, in addition to FVC and TL,co, to monitor treatment efficacy in patients with interstitial lung diseases.

Keywords: 6-minute walk distance; 6-minute walk test; desaturation; distance-saturation product; distance/desaturation index; hypersensitivity pneumonitis.

Grants and funding

This research received no external funding.