Predicting outcome in idiopathic pulmonary fibrosis: Addition of fibrotic score at thin-section ct of the chest to gender, age, and physiology score improves the prediction model

Academic Article


  • Purpose: To assess the impact of adding thin-section CT–derived semiquantitative fibrotic score to gender, age, and physiology (GAP) model for predicting survival in idiopathic pulmonary fibrosis (IPF). Materials and Methods: In this retrospective study of 194 patients with IPF, primary outcome was transplant-free survival. Two thoracic radiologists visually estimated the percentage of reticulation and honeycombing at baseline thin-section CT, which were added to give fibrotic score. For analysis, fibrotic score cutoff (x) determined by using receiver operating characteristic analysis categorized patients into group A (3). Combining the above categories gave four groups (A1, A2, B1, B2). Kaplan-Meier survival analysis was performed with comparison statistics (log-rank test), and hazard ratios were calculated by using the Cox model. Results: The study patients included 141 men (72.7%), with average age of 66.1 years ± 9.1 (standard deviation). Eighty-four patients (43.3%) has stage I disease with a median follow up of 3.3 years. The interobserver agreement for thin-section CT fibrotic score was substantial (83.3%; k = 0.64). The optimal cutoff for fibrotic score was 25% (x), with area under the curve of 0.654 (95% confidence interval [CI]: 0.569, 0.74). Survival for group A1 was significantly better than in the other three groups (P <.001). The hazard ratios for respective groups were as follows: B1 was 4.03 (95% CI: 2.02, 8.07), A2 was 4.10 (95% CI: 1.89, 8.87), and B2 was 5.62 (95% CI: 2.86, 11.06) (P <.001 for all). Within the group with GAP score less than or equal to 3 (A1, B1), participants with higher fibrotic score (B1) had four times the increased risk of death or transplantation (P <.001). Conclusion: Incorporating semiquantitative fibrotic score from thin-section CT to GAP score provides an improved prediction model for survival in idiopathic pulmonary fibrosis.
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    Author List

  • Chahal A; Sharif R; Watts J; de Andrade J; Luckhardt T; Kim YI; Ramchandran R; Sonavane S
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  • 1
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  • 2