Idiopathic pulmonary fibrosis: survival in population based and hospital based cohorts
Idiopathic pulmonary fibrosis: survival in population based and hospital based cohorts
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DOI：
10.1136/thx.53.6.469
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发表时间：
1998-06-01
期刊：
影响因子：
10
通讯作者：
Coultas, DB
中科院分区：
文献类型：
--
作者：
Mapel, DW;Hunt, WC;Coultas, DB
背景-为了确定基于医院的临床系列研究结果是否可以扩展到一般人群中的特发性肺纤维化 (IPF) 患者，将基于人群的登记处的 IPF 患者的生存率与在主要转诊医院接受治疗的一组 IPF 患者的生存率进行了比较，并确定了影响基于人群的登记处的生存率的因素。方法-来自新墨西哥州间质性肺疾病登记处的 209 名 IPF 患者和由 248 名 IPF 患者组成的队列的生存率正在参加一项多中心病例对照研究进行比较。使用生命表和比例风险模型方法确定登记组患者生存的决定因素。结果-登记组和病例对照队列中 IPF 患者的中位生存时间相似（分别为 4.2 年和 4.1 年），尽管登记组患者诊断时的平均年龄更大（71.7 岁与 60.6 岁，p < 0.01）。调整年龄、性别和种族差异后，登记处患者的死亡率在诊断后 6 个月内较高（相对风险 (RH) 6.32，95% CI 2.19 至 18.22），但诊断后 18 个月以上死亡率低于病例对照研究患者（RH 0.35，95% CI 0.19 至 0.66）。登记中与较差预后相关的因素包括高龄、严重的影像学异常、用力肺活量严重下降以及皮质类固醇治疗史。结论——一般人群中IPF患者的调整后生存率与转诊医院的生存率不同，这表明选择偏差影响转诊医院的生存体验。
Background-To ascertain whether findings from hospital based clinical series can be extended to patients with idiopathic pulmonary fibrosis (IPF) in the general population, the survival of patients with IPF in a population based registry was compared with that of a cohort of patients with IPF treated at major referral hospitals and the factors influencing survival in the population based registry were identified.Methods-The survival of 209 patients with IPF from the New Mexico Interstitial Lung Disease Registry and a cohort of 248 patients with IPF who were participating in a multicentre case-control study was compared. The determinants of survival for the patients from the Registry were determined using life table and proportional hazard modelling methods.Results-The median survival times of patients with IPF in the Registry and case-control cohorts were similar (4.2 years and 4.1 years, respectively), although the average age at diagnosis of the Registry patients was greater (71.7 years versus 60.6 years, p < 0.01). After adjusting for differences in age, sex, and ethnicity, the death rate within six months of diagnosis was found to be greater in the Registry patients (relative hazard (RH) 6.32, 95% CI 2.19 to 18.22) but more than 18 months after diagnosis the death rate was less (RH 0.35, 95% CI 0.19 to 0.66) than in the patients in the case-control study. Factors associated with poorer prognosis in the Registry included advanced age, severe radiographic abnormalities, severe reduction in forced vital capacity, and a history of corticosteroid treatment.Conclusions-The adjusted survival of patients with IPF in the general population is different from that of hospital referrals which suggests that selection biases affect the survival experience of referral hospitals.