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Kreuter M, Lee JS, Tzouvelekis A, Oldham JM, Molyneaux PL, Weycker D, Atwood M, Samara K, Kirchgässler KU, Maher TM. Modified blood cell GAP model as a prognostic biomarker in idiopathic pulmonary fibrosis. ERJ Open Res 2024; 10:00666-2023. [PMID: 39076530 PMCID: PMC11284599 DOI: 10.1183/23120541.00666-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/29/2024] [Indexed: 07/31/2024] Open
Abstract
Background The Gender, Age and Physiology (GAP) model is a simple mortality prediction tool in patients with idiopathic pulmonary fibrosis that uses demographic and physiological variables available at initial evaluation. White blood cell variables may have associations with idiopathic pulmonary fibrosis outcomes. We evaluated whether incorporating blood cell counts in modified GAP (cGAP) models would improve outcome prediction in patients with idiopathic pulmonary fibrosis. Patients and methods This retrospective analysis included pooled data from phase 3 randomised trials of pirfenidone in idiopathic pulmonary fibrosis (ASCEND, CAPACITY 004, CAPACITY 006). Study outcomes (disease progression, all-cause mortality, all-cause hospitalisation, respiratory-related hospitalisation) were evaluated during the initial 1-year period. Shared frailty models were used to evaluate associations between continuous and categorical baseline white and red blood cell parameters and study outcomes in a bivariate context, and to evaluate the impact of adding continuous monocyte count (cGAP1) or white and red blood cell parameters (cGAP2) to traditional GAP variables in a multivariable context based on C-statistics changes. Results Data were pooled from 1247 patients (pirfenidone, n=623; placebo, n=624). Significant associations (bivariate analyses) were idiopathic pulmonary fibrosis progression with neutrophil and eosinophil counts; all-cause mortality with monocyte and neutrophil counts; all-cause hospitalisation with monocyte count, neutrophil count and haemoglobin level; and respiratory-related hospitalisation with monocyte count, neutrophil count and haemoglobin level. In multivariate analyses, C-statistics were highest for the cGAP2 model for each of the outcomes. Conclusion Modified GAP models incorporating monocyte counts alone or plus other white and red blood cell variables may be useful to improve prediction of outcomes in patients with idiopathic pulmonary fibrosis.
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Affiliation(s)
- Michael Kreuter
- Center for Pulmonary Medicine, Departments of Pneumology, Mainz University Medical Center, and of Pulmonary, Critical Care and Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Joyce S. Lee
- Department of Medicine, University of Colorado, Denver, CO, USA
| | | | - Justin M. Oldham
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Philip L. Molyneaux
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | | | | | - Toby M. Maher
- National Heart and Lung Institute, Imperial College London, London, UK
- Hastings Center for Pulmonary Research and Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Di J, Li X, Yang J, Li L, Yu X. Bias and Reporting Quality of Clinical Prognostic Models for Idiopathic Pulmonary Fibrosis: A Cross-Sectional Study. Healthc Policy 2022; 15:1189-1201. [PMID: 35702399 PMCID: PMC9188804 DOI: 10.2147/rmhp.s357606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to evaluate the risk of bias (ROB) and reporting quality of idiopathic pulmonary fibrosis (IPF) prediction models by assessing characteristics of these models. Methods The development and/or validation of IPF prognostic models were identified via an electronic search of PubMed, Embase, and Web of Science (from inception to 12 August, 2021). Two researchers independently assessed the risk of bias (ROB) and reporting quality of IPF prediction models based on the Prediction model Risk Of Bias Assessment Tool (PROBAST) and Transparent Reporting of a multivariable prognostic model for Individual Prognosis or Diagnosis (TRIPOD) checklist. Results Twenty prognostic model studies for IPF were included, including 7 (35%) model development and external validation studies, 8 (40%) development studies, and 5 (25%) external validation studies. According to PROBAST, all studies were appraised with high ROB, because of deficient reporting in the domains of participants (45.0%) and analysis (67.3%), and at least 55% studies were susceptible to 4 of 20 sources of bias. For the reporting quality, none of them completely adhered to the TRIPOD checklist, with the lowest mean reporting score for the methods and results domains (46.6% and 44.7%). For specific items, eight sub-items had a reporting rate ≥80% and adhered to the TRIPOD checklist, and nine sub-items had a very poor reporting rate, less than 30%. Conclusion Studies adhering to PROBAST and TRIPOD checklists are recommended in the future. The reproducibility and transparency can be improved when studies completely adhere to PROBAST and TRIPOD checklists.
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Affiliation(s)
- Jiaqi Di
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R, Henna University of Chinese Medicine, Zhengzhou, 450046, People’s Republic of China
| | - Xuanlin Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R, Henna University of Chinese Medicine, Zhengzhou, 450046, People’s Republic of China
| | - Jingjing Yang
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R, Henna University of Chinese Medicine, Zhengzhou, 450046, People’s Republic of China
| | - Luguang Li
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Xueqing Yu
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
- Correspondence: Xueqing Yu, Email
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Harari S, Specchia C, Lipsi R, Cassandro R, Caminati A. Older Idiopathic Pulmonary Fibrosis Male Patients Are at a Higher Risk of Nintedanib Dose Reduction. Respiration 2020; 99:646-648. [DOI: 10.1159/000508667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022] Open
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De Sadeleer LJ, Goos T, Yserbyt J, Wuyts WA. Towards the Essence of Progressiveness: Bringing Progressive Fibrosing Interstitial Lung Disease (PF-ILD) to the Next Stage. J Clin Med 2020; 9:E1722. [PMID: 32503224 PMCID: PMC7355916 DOI: 10.3390/jcm9061722] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/19/2022] Open
Abstract
Although only recently introduced in the ILD community, the concept of progressive fibrosing interstitial lung disease (PF-ILD) has rapidly acquired an important place in the management of non-idiopathic pulmonary fibrosis fibrosing ILD (nonIPF fILD) patients. It confirms a clinical gut feeling that an important subgroup of nonIPF fILD portends a dismal prognosis despite therapeutically addressing the alleged triggering event. Due to several recently published landmark papers showing a treatment benefit with currently available antifibrotic drugs in PF-ILD patients, endorsing a PF-ILD phenotype has vital therapeutic consequences. Importantly, defining progressiveness is based on former progression, which has proven to be a rather moderate predictor of future progression. As fibrosis extent >20% and the presence of honeycombing have superior predictive properties regarding future progression, we advocate immediate initiation of antifibrotic treatment in the presence of these risk factors. In this perspective, we describe the historical context wherein PF-ILD has emerged, determine the currently employed PF-ILD criteria and their inherent limitations and propose new directions to mature its definition. Finally, while ascertaining progression in a nonIPF fILD patient clearly demonstrates the need for (additional) therapy, in the future, therapeutic decisions should be taken after assessing which pathway is ultimately driving the progression. Although not readily available, pathophysiological insight and diagnostic means are emergent to go full steam ahead in this novel direction.
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Affiliation(s)
- Laurens J. De Sadeleer
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, B-3000 Leuven, Belgium; (L.J.D.S.); (T.G.); (J.Y.)
- Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Tinne Goos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, B-3000 Leuven, Belgium; (L.J.D.S.); (T.G.); (J.Y.)
- Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Jonas Yserbyt
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, B-3000 Leuven, Belgium; (L.J.D.S.); (T.G.); (J.Y.)
| | - Wim A. Wuyts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, B-3000 Leuven, Belgium; (L.J.D.S.); (T.G.); (J.Y.)
- Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, B-3000 Leuven, Belgium
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Tran T, Šterclová M, Mogulkoc N, Lewandowska K, Müller V, Hájková M, Kramer MR, Jovanović D, Tekavec-Trkanjec J, Studnicka M, Stoeva N, Hejduk K, Dušek L, Suissa S, Vašáková M. The European MultiPartner IPF registry (EMPIRE): validating long-term prognostic factors in idiopathic pulmonary fibrosis. Respir Res 2020; 21:11. [PMID: 31915023 PMCID: PMC6951015 DOI: 10.1186/s12931-019-1271-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/29/2019] [Indexed: 01/03/2023] Open
Abstract
Background Several registries of idiopathic pulmonary fibrosis (IPF) have been established to better understand its natural history, though their size and duration of follow-up are limited. Here, we describe the large European MultiPartner IPF Registry (EMPIRE) and validate predictors of long-term survival in IPF. Methods The multinational prospective EMPIRE registry enrolled IPF patients from 48 sites in 10 Central and Eastern European countries since 2014. Survival from IPF diagnosis until death was estimated, accounting for left-truncation. The Cox proportional hazards regression model was used to estimate adjusted hazard ratios (HR) of death for prognostic factors, using restricted cubic splines to fit continuous factors. Results The cohort included 1620 patients (mean age at diagnosis 67.6 years, 71% male, 63% smoking history), including 75% enrolled within 6 months of diagnosis. Median survival was 4.5 years, with 45% surviving 5 years post-diagnosis. Compared with GAP stage I, mortality was higher with GAP stages II (HR 2.9; 95% CI: 2.3–3.7) and III (HR 4.0; 95% CI: 2.8–5.7) while, with redefined cut-offs, the corresponding HRs were 2.7 (95% CI: 1.8–4.0) and 5.8 (95% CI: 4.0–8.3) respectively. Mortality was higher with concurrent pulmonary hypertension (HR 2.0; 95% CI: 1.5–2.9) and lung cancer (HR 2.6; 95% CI: 1.3–4.9). Conclusions EMPIRE, one of the largest long-term registries of patients with IPF, provides a more accurate confirmation of prognostic factors and co-morbidities on longer term five-year mortality. It also suggests that some fine-tuning of the indices for mortality may provide a more accurate long-term prognostic profile for these patients.
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Affiliation(s)
- Tanja Tran
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Martina Šterclová
- Department of Respiratory Medicine of the First Faculty of Medicine Charles University, Thomayer Hospital, Vídeňská 800, 140 59, Prague 4, Czech Republic
| | - Nesrin Mogulkoc
- Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Katarzyna Lewandowska
- 1st Department of Pulmonary Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Veronika Müller
- Department of Pulmonology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Marta Hájková
- Clinic of Pneumology and Phthisiology, University Hospital Bratislava, Bratislava, Slovakia
| | - Mordechai R Kramer
- Institute of Pulmonary Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Dragana Jovanović
- University Hospital of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - Natalia Stoeva
- Department of Pulmonology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Karel Hejduk
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Dušek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Samy Suissa
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Martina Vašáková
- Department of Respiratory Medicine of the First Faculty of Medicine Charles University, Thomayer Hospital, Vídeňská 800, 140 59, Prague 4, Czech Republic.
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Bilgili H, Białas AJ, Górski P, Piotrowski WJ. Telomere Abnormalities in the Pathobiology of Idiopathic Pulmonary Fibrosis. J Clin Med 2019; 8:jcm8081232. [PMID: 31426295 PMCID: PMC6723768 DOI: 10.3390/jcm8081232] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) occurs primarily in older adults and the incidence is clearly associated with aging. This disease seems to be associated with several hallmarks of aging, including telomere attrition and cellular senescence. Increasing evidence suggests that abnormalities involving telomeres and their proteome play a significant role in the pathobiology of IPF. The aim of this study is to summarize present knowledge in the field, as well as to discuss its possible clinical implications. Numerous mutations in genes associated with telomere functioning were studied in the context of IPF, mainly for Telomerase Reverse Transcriptase (TERT) and Telomerase RNA Component (TERC). Such mutations may lead to telomere shortening, which seems to increase the risk of IPF, negatively influence disease progression, and contribute to worse prognosis after lung transplantation. Some evidence indicates the possibility for the use of telomerase activators as potential therapeutic agents in pulmonary fibrosis. To sum up, increasing evidence suggests the role of telomere abnormalities in the pathobiology of IPF, natural history and prognosis of the disease. There are also possibilities for telomerase targeting in the potential development of new treatment agents. However, all these aspects require further research.
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Affiliation(s)
- Hasancan Bilgili
- Department of Pneumology and Allergy, Medical University of Lodz, 90-154 Lodz, Poland
| | - Adam J Białas
- Department of Pneumology and Allergy, Medical University of Lodz, 90-154 Lodz, Poland.
| | - Paweł Górski
- Department of Pneumology and Allergy, Medical University of Lodz, 90-154 Lodz, Poland
| | - Wojciech J Piotrowski
- Department of Pneumology and Allergy, Medical University of Lodz, 90-154 Lodz, Poland
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