Received by the Editorial Office: 22.04.2026
Accepted for publication: 18.05.2026
Published online 30.06.2026
UDC: 616.24-002.17-036.1-037
DOI: 10.26212/2227-1937.2026.60.22.009
RISK FACTORS AND PREDICTORS OF ADVERSE COURSE OF INTERSTITIAL LUNG DISEASES: A LITERATURE REVIEW
Zhadil A.D. ¹,², Kassenova S.L. ¹, Vinnikov D.V. ³, Avdeev S.N. ⁴,
Tuleutayev R.M. ¹, Kaibullaeva D.A. ¹, Kalykova M.B. ¹
¹ Research Institute of Cardiology and Internal Diseases JSC, Almaty, Kazakhstan
² Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
³ Al-Farabi Kazakh National University, Almaty, Kazakhstan
⁴ I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Introduction. Interstitial lung diseases (ILDs) are a heterogeneous group of disorders characterized by inflammation and/or fibrosis of the lung parenchyma and frequently leading to progressive respiratory failure. A substantial proportion of patients develop a progressive fibrosing phenotype associated with an unfavorable prognosis.
Objective. To analyze current evidence on risk factors for progression and predictors of adverse outcomes in interstitial lung diseases.
Materials and methods. This study was conducted as a narrative literature review. The literature search was performed in PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, predominantly covering 2015-2025, using Russian- and English-language keywords related to interstitial lung diseases, progressive pulmonary fibrosis, risk factors, and functional, radiological, and laboratory predictors. A total of 50 sources were included, comprising systematic reviews, meta-analyses, cohort studies, registry data, clinical guidelines, and expert consensus statements.
Results. The most clinically significant and reproducible predictors of ILD progression are a decline in forced vital capacity (FVC), a decrease in diffusing capacity of the lungs for carbon monoxide (DLCO), progression of fibrotic changes on high-resolution computed tomography (HRCT), and the presence of traction bronchiectasis, honeycombing, and a usual interstitial pneumonia pattern. Additional prognostic value is associated with clinical deterioration, increasing dyspnea, exercise-induced desaturation, reduced six-minute walk distance, older age, smoking, and occupational, domestic, and environmental inhalational exposures. Laboratory and molecular markers may complement risk assessment; however, most of them are not yet sufficiently standardized for independent use in routine clinical practice.
Discussion. The adverse course of ILDs is determined not by a single isolated factor but by the combined influence of functional, radiological, clinical, exposure-related, and laboratory parameters. In idiopathic pulmonary fibrosis, decline in lung function and the presence of a usual interstitial pneumonia pattern more often reflect irreversible fibrosis and are associated with a poorer prognosis. In connective tissue disease-associated ILDs, the same parameters may have a more variable interpretation because the disease course depends on the activity of systemic inflammation and response to therapy.
Conclusion. ILD progression requires early risk stratification based on a multifactorial approach. Routine follow-up should include dynamic assessment of FVC, DLCO, clinical symptoms, exercise tolerance, exercise-induced desaturation, and HRCT signs of fibrosis. Detailed assessment of occupational, domestic, and environmental exposure history is also important. Development and validation of prognostic models integrating functional, radiological, clinical, exposure-related, and laboratory parameters represent a promising direction for individualized risk assessment in ILDs.
Keywords: interstitial lung diseases; progressive pulmonary fibrosis; risk factors; forced vital capacity; high-resolution computed tomography.
