Nurmi Hanna M, Purokivi Minna K, Kärkkäinen Miia S, Kettunen Hannu-Pekka, Selander Tuomas A, Kaarteenaho Riitta L
Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, POB 100, 70029, Kuopio, Finland.
Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland.
BMC Pulm Med. 2017 Jan 13;17(1):16. doi: 10.1186/s12890-016-0358-2.
Risk predicting models have been applied in idiopathic pulmonary fibrosis (IPF), but still not validated in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). The purpose of this study was to test the suitability of three prediction models as well as individual lung function and demographic factors for evaluating the prognosis of RA-ILD patients.
Clinical and radiological data of 59 RA-ILD patients was re-assessed. GAP (gender, age, physiologic variables) and the modified interstitial lung disease (ILD)-GAP as well as the composite physiologic indexes (CPI) were tested for predicting mortality using the goodness-of-fit test and Cox model. Potential predictors of mortality were also sought from single lung function parameters and clinical characteristics.
The median survival was 152 and 61 months in GAP / ILD-GAP stages I and II (p = 0.017). Both GAP and ILD-GAP models accurately estimated 1-year, 2-year and 3-year mortality. CPI (p = 0.025), GAP (p = 0.008) and ILD-GAP (p = 0.028) scores, age (p = 0.002), baseline diffusion capacity to carbon monoxide (DLCO) (p = 0.014) and hospitalization due to respiratory reasons (p = 0.039), were significant predictors of mortality in the univariate analysis, whereas forced vital capacity (FVC) was not predictive. CPI score (HR 1.03, p = 0.018) and baseline DLCO (HR 0.97, p = 0.011) remained significant predictors of mortality after adjusting for age.
GAP and ILD-GAP are applicable for evaluating the risk of death of patients with RA-ILD in a similar manner as in those with IPF. Baseline DLCO and CPI score also predicted survival.
风险预测模型已应用于特发性肺纤维化（IPF），但尚未在类风湿关节炎相关间质性肺病（RA-ILD）患者中得到验证。本研究的目的是测试三种预测模型以及个体肺功能和人口统计学因素对评估RA-ILD患者预后的适用性。
对59例RA-ILD患者的临床和放射学数据进行重新评估。使用拟合优度检验和Cox模型测试GAP（性别、年龄、生理变量）和改良的间质性肺病（ILD）-GAP以及综合生理指标（CPI）对死亡率的预测能力。还从单肺功能参数和临床特征中寻找死亡率的潜在预测因素。
GAP/ILD-GAP I期和II期患者的中位生存期分别为152个月和61个月（p = 0.017）。GAP和ILD-GAP模型均准确估计了1年、2年和3年死亡率。单因素分析中，CPI（p = 0.025）、GAP（p = 0.008）和ILD-GAP（p = 0.028）评分、年龄（p = 0.002）、基线一氧化碳弥散量（DLCO）（p = 0.014）和因呼吸原因住院（p = 0.039）是死亡率的显著预测因素，而用力肺活量（FVC）无预测作用。调整年龄后，CPI评分（HR 1.03，p = 0.018）和基线DLCO（HR 0.97，p = 0.011）仍是死亡率的显著预测因素。
GAP和ILD-GAP适用于评估RA-ILD患者的死亡风险，其方式与IPF患者相似。基线DLCO和CPI评分也可预测生存期。
