Clinical and prognostic implications of honeycombing in patients diagnosed with NSIP

This study aimed to evaluate the clinical, radiological and treatment characteristics of patients diagnosed with nonspecific interstitial pneumonia (NSIP) between 2012 and 2017. In addition, we investigated the association of these findings with survival outcomes in the context of contemporary treatment strategies. This single-centre, retrospective cohort study included 79 patients with NSIP. Demographic data, comorbidities, modified Medical Research Council dyspnoea scores, high-resolution computed tomography (HRCT) findings, pulmonary function test results, administered immunosuppressive agents and clinical course data were recorded. The mean age of the cohort was 66.3 ± 10.3 (range: 41–87) years, and 45.6% and 54.4% of them were female and male, respectively. At least one comorbidity was present in 78.5% of patients, cardiovascular disease being the most frequent. Ground-glass opacity was the most common thoracic HRCT finding (91.1%). A honeycombing pattern was present in 40.5% of patients and was associated with mortality (log-rank p = 0.009; univariable Cox HR 3.49, 95% CI 1.29–9.46). Immunosuppressive therapy was administered to 74.6% of patients. There was no significant difference in the survival of the treated and untreated groups (log-rank p = 0.320). Overall survival was calculated as 66.1 months (95% CI: 58.7–73.5). The results suggest that a honeycombing pattern may be associated with a worse prognosis in NSIP. The width of the confidence interval and the modest number of events mean this should be regarded as a hypothesis-generating observation requiring prospective confirmation. No significant survival difference was observed between treated and untreated patients, although the small number of events in the untreated group limits the interpretation of this comparison. These findings support the individualisation of treatment decisions in NSIP based on clinical and radiological prognostic features.