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. 2022 Jan-Dec:16:17534666221135316.
doi: 10.1177/17534666221135316.

Mortality risk prediction with ILD-GAP index in a fibrotic hypersensitivity pneumonitis cohort

Leonor Mendonça Almeida  1 , Ana Luísa Fernandes  2 , Catarina Gouveia Cardoso  3 , Bruno Lima  4 , Inês Neves  2 , Hélder Novais-Bastos  3   5   6 , Patrícia Caetano Mota  3   5 , Natália Melo  3 , Conceição Souto Moura  5   7 , Susana Guimarães  5   7 , André Carvalho  5   8 , Rui Cunha  5   8 , José Miguel Pereira  5   8 , António Morais  3   5   6
Affiliations

Mortality risk prediction with ILD-GAP index in a fibrotic hypersensitivity pneumonitis cohort

Leonor Mendonça Almeida et al. Ther Adv Respir Dis. 2022 Jan-Dec.

Abstract

Background: Fibrotic hypersensitivity pneumonitis (fHP) is associated with significant morbidity and mortality. Interstitial lung disease-gender-age-physiology (ILD-GAP) performance in fHP outside the initial cohort was never performed.

Aim: To assess the ILD-GAP index's ability to predict mortality in a Portuguese cohort of patients with fHP and analyse whether other clinical variables add value.

Methods: Retrospective analysis of fHP cohort in two Portuguese ILD centres. The baseline ILD-GAP index was calculated. Survival was analysed in months; mortality was the primary outcome. Univariate and multivariate analyses to identify mortality risk factors were performed.

Results: A total of 141 patients were included. Fifty-three patients (37.6%) died during the follow-up. The usual interstitial pneumonia (UIP) pattern was found in 49.6%, and their survival was inferior to non-UIP [32 months (interquartile range, IQR = 19, 60) versus 52 months (IQR = 28, 98), p = 0.048]. Patients with an ILD-GAP index higher than three double their risk of mortality [hazard ratio (HR) = 6.48, 95% confidence interval (CI) = (3.03-13.96)] when compared with the patients with an index between 2 and 3 [HR = 3.04, 95% CI = (1.62-5.71)] adjusting for acute exacerbation history. Even though UIP patients had worse survival, it did not reach statistical significance when UIP pattern was added to this model. Acute exacerbation history was an independent risk factor for mortality; however, ILD-GAP still predicted mortality after adjusting for this factor. PaO2 and 6-minute walk test desaturation were not significant risk factors.

Conclusion: ILD-GAP index is a good predictor for mortality in fHP, even after adjusting for other mortality risk factors.

Keywords: ILD-GAP; chronic hypersensitivity pneumonitis; fibrotic interstitial lung disease.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Survival curves for UIP and non-UIP patients. p value for log-rank test.
Figure 2.
Figure 2.
Survival curves for ILD-GAP index – complete follow-up. p value for log-rank test.
Figure 3.
Figure 3.
Survival curves for ILD-GAP index – 36 months. p value for log-rank test.
See this image and copyright information in PMC

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