Predicting survival in idiopathic pulmonary fibrosis: Scoring system and survival model
Predicting survival in idiopathic pulmonary fibrosis: Scoring system and survival model
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DOI：
10.1164/ajrccm.164.7.2003140
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发表时间：
2001-10-01
影响因子：
24.7
通讯作者：
Cherniack, RM
中科院分区：
文献类型：
--
作者：
King, TE;Tooze, JA;Cherniack, RM
我们的目的是确定生存的临床、放射学和生理学（CRP）决定因素，并开发一种CRP评分系统，用于预测新诊断的特发性肺纤维化（IPF）病例的生存率。研究人群包括238例活检证实的普通型间质性肺炎患者。对每例患者的临床表现、胸片和肺生理学进行前瞻性评估。我们使用考克斯比例风险模型来评估这些参数对生存率的影响。年龄和吸烟的影响也包括在分析中。生存率与年龄、吸烟状态（目前吸烟者吸烟时间较长）、杵状、间质混浊程度和胸片上肺动脉高压的存在、肺容量减少和最大运动时气体交换异常有关。从这些参数中推导出用于预测生存率的CRP数学评分。我们发现CRP评分与IPF重要组织病理学特征的范围和严重程度相关，即，纤维化、细胞结构、肉芽/结缔组织沉积和总病理紊乱。使用这些模型，临床医生能够更好地为IPF患者提供预后信息，并改善最适合肺移植或其他标准或新型治疗干预的患者的选择。
Our purpose was to identify clinical, radiological and physiological (CRP) determinants of survival and to develop a CRP scoring system that predicts survival in newly diagnosed cases of idiopathic pulmonary fibrosis (IPF). The study population consisted of 238 patients with biopsy confirmed usual interstitial pneumonia. For each patient, clinical manifestations, chest radiographs, and pulmonary physiology were prospectively assessed. We used Cox proportional-hazards models to assess the effect of these parameters on survival. The effects of age and smoking were included in the analysis. Survival was related to age, smoking status (longer in current smokers), clubbing, the extent of interstitial opacities and presence of pulmonary hypertension on the chest radiograph, reduced lung volume, and abnormal gas exchange during maximal exercise. A mathematical CRP score for predicting survival was derived from these parameters. We showed that this CRP score correlated with the extent and severity of the important histopathologic features of IPF, i.e., fibrosis, cellularity, the granulation/connective tissue deposition, and the total pathologic derangement. Using these models, clinicians are in a better position to provide prognostic information to patients with IPF and to improve the selection of the most appropriate patients for lung transplantation or other standard or novel therapeutic interventions.