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  • Predicting Survival Across ...
    Ryerson, Christopher J., MD; Vittinghoff, Eric, PhD; Ley, Brett, MD; Lee, Joyce S., MD; Mooney, Joshua J., MD; Jones, Kirk D., MD; Elicker, Brett M., MD; Wolters, Paul J., MD; Koth, Laura L., MD; King, Talmadge E., MD, FCCP; Collard, Harold R., MD, FCCP

    Chest, 04/2014, Letnik: 145, Številka: 4
    Journal Article

    Background Risk prediction is challenging in chronic interstitial lung disease (ILD) because of heterogeneity in disease-specific and patient-specific variables. Our objective was to determine whether mortality is accurately predicted in patients with chronic ILD using the GAP model, a clinical prediction model based on sex, age, and lung physiology, that was previously validated in patients with idiopathic pulmonary fibrosis. Methods Patients with idiopathic pulmonary fibrosis (n = 307), chronic hypersensitivity pneumonitis (n = 206), connective tissue disease-associated ILD (n = 281), idiopathic nonspecific interstitial pneumonia (n = 45), or unclassifiable ILD (n = 173) were selected from an ongoing database (N = 1,012). Performance of the previously validated GAP model was compared with novel prediction models in each ILD subtype and the combined cohort. Patients with follow-up pulmonary function data were used for longitudinal model validation. Results The GAP model had good performance in all ILD subtypes (c-index, 74.6 in the combined cohort), which was maintained at all stages of disease severity and during follow-up evaluation. The GAP model had similar performance compared with alternative prediction models. A modified ILD-GAP Index was developed for application across all ILD subtypes to provide disease-specific survival estimates using a single risk prediction model. This was done by adding a disease subtype variable that accounted for better adjusted survival in connective tissue disease-associated ILD, chronic hypersensitivity pneumonitis, and idiopathic nonspecific interstitial pneumonia. Conclusion The GAP model accurately predicts risk of death in chronic ILD. The ILD-GAP model accurately predicts mortality in major chronic ILD subtypes and at all stages of disease.