The added value of comorbidities in predicting survival in idiopathic pulmonary fibrosis: A multicentre observational study

Sebastiano Emanuele Torrisi; Brett Ley; Michael Kreuter; Marlies Wijsenbeek; Eric Vittinghoff; Harold R. Collard; Carlo Vancheri

doi:10.1183/13993003.01587-2018

The added value of comorbidities in predicting survival in idiopathic pulmonary fibrosis: A multicentre observational study

Sebastiano Emanuele Torrisi, Brett Ley, Michael Kreuter, Marlies Wijsenbeek, Eric Vittinghoff, Harold R. Collard, Carlo Vancheri^*

^*Corresponding author for this work

Pulmonary Medicine

Research output: Contribution to journal › Article › Academic › peer-review

70 Citations (Scopus)

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. Model discrimination was assessed using 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, respectively), and significantly improved the 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 by 2.5, p=0.037). Conclusions: The inclusion of comorbidities in TORVAN models significantly improved the discriminative performance in prediction of risk of death compared to GAP.

Original language	English
Article number	1801587
Journal	European Respiratory Journal
Volume	53
Issue number	3
DOIs	https://doi.org/10.1183/13993003.01587-2018
Publication status	Published - 1 Mar 2019

Bibliographical note

Funding Information:
Conflict of interest: S.E. Torrisi reports grants from Boehringer Ingelheim and F. Hoffmann-La Roche Ltd, outside the submitted work. B. Ley has nothing to disclose. M. Kreuter reports grants from Galapagos, and grants and personal fees from Boehringer Ingelheim and Hoffman la Roche, outside the submitted work. M. Wijsenbeek reports grants and other from Boehringer Ingelheim and Hoffman la Roche, and other from Galapagos, outside the submitted work. E. Vittinghoff has nothing to disclose. H.R. Collard reports personal fees from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Global Blood Therapeutics, Genoa, ImmuneWorks, Navitor, Parexel, PharmAkea, Prometic, Toray, Unity, Patara, Veracyte, Roche/Genentech, aTyr, Advance Medical, Aeolus and MedImmune, grants from Pulmonary Fibrosis Foundation, and grants and personal fees from Three Lakes Partners, outside the submitted work. C. Vancheri reports grants from AstraZeneca, Boehringer Ingelheim, Chiesi, F. Hoffmann-La Roche Ltd and Menarini, outside the submitted work.

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Copyright ©ERS 2019

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10.1183/13993003.01587-2018

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title = "The added value of comorbidities in predicting survival in idiopathic pulmonary fibrosis: A multicentre observational study",

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. Model discrimination was assessed using 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, respectively), and significantly improved the 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 by 2.5, p=0.037). Conclusions: The inclusion of comorbidities in TORVAN models significantly improved the discriminative performance in prediction of risk of death compared to GAP.",

author = "Torrisi, \{Sebastiano Emanuele\} and Brett Ley and Michael Kreuter and Marlies Wijsenbeek and Eric Vittinghoff and Collard, \{Harold R.\} and Carlo Vancheri",

note = "Funding Information: Conflict of interest: S.E. Torrisi reports grants from Boehringer Ingelheim and F. Hoffmann-La Roche Ltd, outside the submitted work. B. Ley has nothing to disclose. M. Kreuter reports grants from Galapagos, and grants and personal fees from Boehringer Ingelheim and Hoffman la Roche, outside the submitted work. M. Wijsenbeek reports grants and other from Boehringer Ingelheim and Hoffman la Roche, and other from Galapagos, outside the submitted work. E. Vittinghoff has nothing to disclose. H.R. Collard reports personal fees from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Global Blood Therapeutics, Genoa, ImmuneWorks, Navitor, Parexel, PharmAkea, Prometic, Toray, Unity, Patara, Veracyte, Roche/Genentech, aTyr, Advance Medical, Aeolus and MedImmune, grants from Pulmonary Fibrosis Foundation, and grants and personal fees from Three Lakes Partners, outside the submitted work. C. Vancheri reports grants from AstraZeneca, Boehringer Ingelheim, Chiesi, F. Hoffmann-La Roche Ltd and Menarini, outside the submitted work. Publisher Copyright: Copyright {\textcopyright}ERS 2019",

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doi = "10.1183/13993003.01587-2018",

language = "English",

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T1 - The added value of comorbidities in predicting survival in idiopathic pulmonary fibrosis

T2 - A multicentre observational study

AU - Torrisi, Sebastiano Emanuele

AU - Ley, Brett

AU - Kreuter, Michael

AU - Wijsenbeek, Marlies

AU - Vittinghoff, Eric

AU - Collard, Harold R.

AU - Vancheri, Carlo

N1 - Funding Information: Conflict of interest: S.E. Torrisi reports grants from Boehringer Ingelheim and F. Hoffmann-La Roche Ltd, outside the submitted work. B. Ley has nothing to disclose. M. Kreuter reports grants from Galapagos, and grants and personal fees from Boehringer Ingelheim and Hoffman la Roche, outside the submitted work. M. Wijsenbeek reports grants and other from Boehringer Ingelheim and Hoffman la Roche, and other from Galapagos, outside the submitted work. E. Vittinghoff has nothing to disclose. H.R. Collard reports personal fees from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Global Blood Therapeutics, Genoa, ImmuneWorks, Navitor, Parexel, PharmAkea, Prometic, Toray, Unity, Patara, Veracyte, Roche/Genentech, aTyr, Advance Medical, Aeolus and MedImmune, grants from Pulmonary Fibrosis Foundation, and grants and personal fees from Three Lakes Partners, outside the submitted work. C. Vancheri reports grants from AstraZeneca, Boehringer Ingelheim, Chiesi, F. Hoffmann-La Roche Ltd and Menarini, outside the submitted work. Publisher Copyright: Copyright ©ERS 2019

PY - 2019/3/1

Y1 - 2019/3/1

N2 - 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. Model discrimination was assessed using 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, respectively), and significantly improved the 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 by 2.5, p=0.037). Conclusions: The inclusion of comorbidities in TORVAN models significantly improved the discriminative performance in prediction of risk of death compared to GAP.

AB - 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. Model discrimination was assessed using 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, respectively), and significantly improved the 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 by 2.5, p=0.037). Conclusions: The inclusion of comorbidities in TORVAN models significantly improved the discriminative performance in prediction of risk of death compared to GAP.

UR - https://www.scopus.com/pages/publications/85062643255

U2 - 10.1183/13993003.01587-2018

DO - 10.1183/13993003.01587-2018

M3 - Article

C2 - 30578385

AN - SCOPUS:85062643255

SN - 0903-1936

VL - 53

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 3

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ER -

The added value of comorbidities in predicting survival in idiopathic pulmonary fibrosis: A multicentre observational study

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