Predictors of stability in CTD-ILD

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Background: Identifying patients with CTD-ILD who are likely to remain stable is crucial for optimizing management and preventing unnecessary inclusion in randomized controlled trials. However, predicting ILD stability remains challenging. Objective: To identify factors predicting stable ILD in CTD-ILD patients. Method: We prospectively followed 103 CTD-ILD patients at Oslo University Hospital with baseline and 12-months assessments. Stable ILD was defined by: stable respiratory symptoms, absolute FVC decline<5%, absolute DLCO decline<10%, stable ILD on HRCT, and no lung transplant or death. Logistic regression adjusting for age and sex identified baseline predictors of stable ILD. Results: Of 103 patients, 37 (36%) were stable over 12 months. Definitive UIP (OR 0.20, CI (0.04-0.94), p=0.04) and radiologic fibrosis, regardless of UIP pattern (OR 0.20, CI 0.08-0.51, p=0.001), predicted less stable ILD. A greater six-minute walk distance (6MWD) (OR 1.17 per 30 m increment, p=0.01) and higher DLCO%pred (OR 1.14 per 5% increment, p=0.02) predicted stable ILD. In multivariable analysis, radiologic fibrosis remained the only significant predictor of less stable ILD. Demographics, CTD subtype, smoking, and baseline FVC did not predict stable ILD. Conclusion: Radiologic fibrosis was a strong predictor of less stable ILD in CTD patients, regardless of UIP pattern. Patients with preserved DLCO and 6MWD were more likely to be stable, with these parameters outperforming FVC as predictors. erj;66/suppl_69/PA6105/F1 F1 F1

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