Predicting Survival Across Chronic Interstitial Lung Disease The ILD-GAP Model
Predicting Survival Across Chronic Interstitial Lung Disease The ILD-GAP Model
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DOI：
10.1378/chest.13-1474
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发表时间：
2014-04-01
期刊：
影响因子：
9.6
通讯作者：
Collard, Harold R.
中科院分区：
文献类型：
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作者：
Ryerson, Christopher J.;Vittinghoff, Eric;Collard, Harold R.
背景资料：由于疾病特异性和患者特异性变量的异质性，慢性间质性肺疾病（ILD）的风险预测具有挑战性。我们的目的是确定使用差距模型是否可以准确预测慢性ILD患者的死亡率，GAP模型是一种基于性别、年龄和肺生理学的临床预测模型，先前在特发性肺纤维化患者中得到验证。特发性肺纤维化患者（n = 307），慢性过敏性肺炎患者（n = 206），结缔组织病相关ILD（n = 281）、特发性非特异性间质性肺炎（n = 45）或无法分类的ILD（n = 173）选自正在进行的数据库（N = 1，012）。在每种ILD亚型和合并队列中，将先前验证的GAP模型的性能与新型预测模型进行比较。随访肺功能数据的患者被用于纵向modelvalidation.Results差距模型在所有ILD亚型（C指数，74.6在合并队列），这是保持在疾病严重程度的所有阶段，并在后续评估良好的性能。差距模型与其他预测模型相比具有相似的性能。开发了一种改良的艾德ILD-GAP指数，用于所有ILD亚型，以使用单一风险预测模型提供疾病特异性生存估计。这是通过增加一个疾病亚型变量，占更好地调整生存结缔组织病相关的ILD，慢性过敏性肺炎，特发性非特异性间质性pneumonia.Conclusion差距模型准确预测慢性ILD的死亡风险。ILD-GAP模型可准确预测主要慢性ILD亚型和疾病所有阶段的死亡率。
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 nonspecifi c interstitial pneumonia (n = 45), or unclassifi able 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 modifi ed ILD-GAP Index was developed for application across all ILD subtypes to provide diseasespecifi c 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 nonspecifi c 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.