Organizing pneumonia (OP) is a histopathologic pattern of response to
lung injury.
Fibrin is a marker of acute microvascular injury, and variable amounts of intraalveolar
fibrin are seen in OP; however, its relevance to clinical outcomes is unclear. We examined lung wedge biopsies of 26 patients with
cryptogenic organizing pneumonia (COP), assessed the amount of
fibrin associated with airspace organization, and correlated
fibrin levels with other histologic, clinical, and radiographic findings. Seven patients with COP had disease relapse. Patients with multifocal
fibrin deposits or acute fibrinous and
organizing pneumonia (collectively, "high
fibrin") showed a higher rate of OP relapse compared to those with no or focal
fibrin (60% versus 6%, P < .05). Patients with radiographic evidence of disease involving all three lung zones (upper, middle, and lower) also showed higher rates of relapse compared to those in whom disease was limited to one or two zones (41% versus 0%, P = .055). In patients with both pathologic evidence of high
fibrin and radiographic evidence of three-zone disease, OP relapse could be predicted with a sensitivity of 86% and specificity of 84% (positive predictive value of 67% and negative predictive value of 94%). The presence of high levels of intraalveolar
fibrin in lung biopsies and radiographic evidence of disease involving all three lung zones is associated with increased risk of relapse in patients with COP, and these features may help identify patients who may benefit from more intensive
steroid therapy.