- Low DLCO is an early risk marker: Baseline DLCO <70% was associated with higher and faster progression to definite SSc.
- DLCO outperforms FVC early: Progressors had reduced DLCO despite similar FVC/TLC, supporting DLCO as a more sensitive early indicator of pulmonary vascular involvement.
- Subclinical decline occurs even without progression: Both DLCO and FVC declined over time in stable VEDOSS, indicating ongoing occult lung involvement.
- Autoantibodies identify higher-risk trajectory: SSc-specific antibody–positive patients showed earlier and greater decline in DLCO (and FVC), reinforcing their prognostic role.
- Clinical implication: Serial PFTs—especially DLCO—should be integrated into routine monitoring of VEDOSS to identify high-risk patients before overt ILD or classification-level SSc develops.
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