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A diagnostic model for chronic hypersensitivity pneumonitis
  1. Kerri A Johannson1,2,
  2. Brett M Elicker3,
  3. Eric Vittinghoff4,
  4. Deborah Assayag5,
  5. Kaïssa de Boer1,
  6. Jeffrey A Golden1,
  7. Kirk D Jones6,
  8. Talmadge E King Jr1,
  9. Laura L Koth1,
  10. Joyce S Lee7,
  11. Brett Ley1,
  12. Paul J Wolters1,
  13. Harold R Collard1
  1. 1 Department of Medicine, University of California, San Francisco, San Francisco, California, USA
  2. 2 Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3 Department of Radiology, University of California, San Francisco, San Francisco, California, USA
  4. 4 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
  5. 5 Montreal Jewish General Hospital, Montreal, Quebec, Canada
  6. 6 Department of Pathology, University of California, San Francisco, San Francisco, California, USA
  7. 7 University of Colorado Denver, Aurora, Colorado, USA
  1. Correspondence to Dr Kerri A Johannson, Department of Medicine, University of Calgary, 6th Floor, 4448 Front Street S.E., Calgary, Alberta, Canada T3M-1M4; kerri.johannson{at}ahs.ca

Abstract

The objective of this study was to develop a diagnostic model that allows for a highly specific diagnosis of chronic hypersensitivity pneumonitis using clinical and radiological variables alone. Chronic hypersensitivity pneumonitis and other interstitial lung disease cases were retrospectively identified from a longitudinal database. High-resolution CT scans were blindly scored for radiographic features (eg, ground-glass opacity, mosaic perfusion) as well as the radiologist's diagnostic impression. Candidate models were developed then evaluated using clinical and radiographic variables and assessed by the cross-validated C-statistic. Forty-four chronic hypersensitivity pneumonitis and eighty other interstitial lung disease cases were identified. Two models were selected based on their statistical performance, clinical applicability and face validity. Key model variables included age, down feather and/or bird exposure, radiographic presence of ground-glass opacity and mosaic perfusion and moderate or high confidence in the radiographic impression of chronic hypersensitivity pneumonitis. Models were internally validated with good performance, and cut-off values were established that resulted in high specificity for a diagnosis of chronic hypersensitivity pneumonitis.

  • Interstitial Fibrosis
  • Hypersensitivity pneumonitis
  • Clinical Epidemiology

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