Idiopathic pulmonary fibrosis: Relationship between histopathologic features and mortality

Talmadge E. King, Marvin I. Schwarz, Kevin Brown, Janet A. Tooze, Thomas V. Colby, James A. Waldron, Andrew Flint, William Thurlbeck, Reuben M. Cherniack

Research output: Contribution to journalArticlepeer-review

504 Scopus citations


It is hypothesized that the extent and severity of fibrosis and cellularity found on lung biopsy determine the prognosis and response to therapy in idiopathic pulmonary fibrosis (IPF). The objective of this study was to determine which histopathologic features predict survival in IPF. We prospectively studied 87 patients with usual interstitial pneumonia (UIP) confirmed by surgical lung biopsy. Four pathologists independently graded the extent and severity of specific histopathologic features. We used Cox proportional-hazards models to assess the effect of histopathologic patterns on patients' survival. The effects of age, sex, and smoking were also included in the analysis. Sixty-three patients died during the 17-yr study period. Survival was longer in subjects with lesser degrees of granulation/connective tissue deposition (fibroblastic foci). The degree of alveolar space cellularity, alveolar wall fibrosis, and cellularity did not affect survival. A history of cigarette smoking, the level of dyspnea, and the degree of lung stiffness at presentation were also shown to be independent factors predicting survival. The extent of fibroblastic foci present on lung biopsy predicts survival in IPF. These findings support the hypothesis that the critical pathway to end-stage fibrosis is not "alveolitis" but rather the ongoing epithelial damage and repair process associated with persistent fibroblastic proliferation. Controlling these processes, rather than stopping inflammation, appears most important in preventing progressive disease and the fatal outcome common in IPF.

Original languageEnglish (US)
Pages (from-to)1025-1032
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Issue number6
StatePublished - Sep 15 2001


  • Idiopathic pulmonary fibrosis
  • Prospective studies
  • Pulmonary fibrosis physiopathology
  • Smoking physiopathology
  • Survival rate
  • Usual interstitial pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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