Korelasi Skor Warrick pada Pemeriksaan High Resolution Computed Tomography Toraks dengan Tes Fungsi Paru Pasien Connective Tissue Disease-Interstitial Lung Disease di Rumah Sakit Adam Malik

Abstract

Background: It is estimated that between 10% and 90% of patients with Connective Tissue Disease (CTD) will develop pulmonary involvement during their lifetime. The prevalence and mortality of Interstitial Lung Disease (ILD) vary among different types of CTD, with secondary ILD prevalence ranging from 1–15% in Systemic Lupus Erythematosus (SLE), 6.5–33% in Rheumatoid Arthritis (RA), 19.9–86% in Polymyositis/Dermatomyositis (PM/DM), 40–91% in Systemic Sclerosis (SSc), 47–90% in Mixed Connective Tissue Disease (MCTD) based on radiological features, and 9–20% in Sjögren’s Syndrome (SS). Reports indicate that ILD-related mortality reaches 20% in RA-ILD, 12–44% in PM/DM, and up to 40% within 10 years in SSc. In patients with RA and SSc, the 5-year mortality rate is three times higher in those with ILD compared to those without ILD. Spirometry is the most commonly used pulmonary function test, typically showing a restrictive pattern characterized by a decrease in forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁), with an increased FEV₁/FVC ratio. In the early stages of the disease, pulmonary function tests may still be normal. In advanced stages, a restrictive pattern is often observed, with reduced FVC and a normal or increased FEV₁/FVC ratio. Objective: To analyze the correlation between the Warrick score on thoracic HRCT and FVC and FEV₁ in patients with CTD-ILD at Adam Malik Hospital, Medan. Methods: This was a cross-sectional study evaluating the correlation between the Warrick score on thoracic HRCT and pulmonary function tests in patients with CTD-ILD at Adam Malik Hospital from January 2021 to July 2025 who met the inclusion criteria. Warrick score assessments were performed by two observers, while pulmonary function test data were obtained from medical records. Results: Of the 41 subjects included, the mean age was 43.2 ± 15.3 years, with a predominance of female patients (30 subjects, 73.2%). Systemic sclerosis was the most common condition, observed in 20 patients (48.8%). The most prevalent dominant Warrick score pattern was ground-glass opacity (GGO), found in 29 patients (70.7%). Based on pulmonary function tests, the severe impairment group was the most common. Statistical analysis demonstrated a moderate negative correlation between the Warrick score and pulmonary function parameters. The correlation coefficient for FVC was –0.565, while for FEV₁ it was –0.588. These findings indicate that higher Warrick scores, representing greater severity and extent of pulmonary abnormalities on HRCT, are associated with lower pulmonary function values. Conclusion: There is a moderate negative correlation between the Warrick score and pulmonary function test parameters.