Abstract
Background The Gender-Age-Physiology (GAP) model was developed to predict the risk of death. Comorbidities are common in Idiopathic pulmonary fibrosis (IPF) and may impact on survival. We evaluated the ability of comorbidities to improve prediction of survival in IPF patients beyond the variables included in the GAP model.
Methods We developed a prediction model named TORVAN using data from two independent cohorts. Continuous and point score prediction-models were developed with estimation of full and sparse versions of both. Models discrimination was assessed by the c-index and calibrated by comparing predicted and observed cumulative mortality at 1–5 years.
Results Discrimination was similar for the sparse continuous model in the derivation and validation cohorts (c-index 71.0 versus 70.0), and significantly improved upon performance of the GAP model in the validation cohort (increase in c-index of 3.8, p=0.001). In contrast, the sparse point-score model did not perform as well in the validation cohort (c-index 72.5 in the derivation cohort versus 68.1 in the validation cohort), but still significantly improved upon the performance of the GAP model (c-index increased of 2.5, p=0.037).
Conclusions The inclusion of comorbidities in TORVAN models significantly improved the discriminative performance in prediction of risk of death comparing to GAP.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Ley has nothing to disclose.
Conflict of interest: Dr. Kreuter reports grants from Galapagos, grants and personal fees from Boehringen Ingelheim , grants and personal fees from Hoffman la Roche, outside the submitted work.
Conflict of interest: Dr. Vittinghoff has nothing to disclose.
Conflict of interest: Dr. Collard reports personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Bristol-Myers Squibb, personal fees from Global Blood Therapeutics, personal fees from Genoa, personal fees from ImmuneWorks, personal fees from Navitor, personal fees from Parexel, personal fees from PharmAkea, personal fees from Prometic, grants from Pulmonary Fibrosis Foundation, grants and personal fees from Three Lakes Partners, personal fees from Toray, personal fees from Unity, personal fees from Patara, personal fees from Veracyte, personal fees from Roche/Genentech, personal fees from aTyr, personal fees from Advance Medical, personal fees from Aeolus, personal fees from MedImmune, outside the submitted work.
Conflict of interest: Dr. Vancheri received an unrestricted grant by Hoffmann–La Roche Std for this study. The sponsor had no role in the study design; in the collection, analysis and interpretation of data; in writing the report and in the decision to submit the report for publication.
Conflict of interest: Dr. Wijsenbeek reports grants and other from Boehringen Ingelheim , grants and other from Hoffman la Roche , other from Galapagos, outside the submitted work.
Conflict of interest: Dr. Torrisi reveived an unrestricted grant by Hoffmann–La Roche Std for this study. The sponsor had no role in the study design; in the collection, analysis and interpretation of data; in writing the report and in the decision to submit the report for publication.
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