Ley et al developed the GAP (gender, age, physiology) score to evaluate patients with interstitial lung disease. This can help to identify a patient who may benefit from more aggressive management or be considered for transplant. The authors are from the University of California San Francisco, the Mayo Clinic and Morgagni-Pierantoni Hospital in Italy.
Patient selection: interstitial lung disease
Outcome: mortality
Parameters:
(1) gender (G)
(2) age in years (A)
(3) FVC as percent of predicted (P)
(4) DLCO as percent of predicted (P)
Parameter
Finding
Points
gender
female
0
male
1
age
<= 60 years
0
61 to 65 years
1
> 65 years
2
FVC
> 75% of predicted
0
50 to 75% of predicted
1
< 50% of predicted
2
DLCO
> 55% of predicted
0
36 to 55% of predicted
1
<= 35% of predicted
2
not performed
3
total score =
= SUM(points for all 4 parameters))
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the worse the survival.
Score
Stage
3 Year Mortality
0 or 3
I (low risk)
16%
4 or 5
II (moderate risk)
42%
6 to 8
III (high risk)
77%
Stage
Lung Transplant
Other Management
I
no immediate need to list
close monitoring with aggressive management
II
consider listing
close moniotring with aggressive management
III
list immediately
palliative care if cannot transplant
Performance:
• The area under the ROC curve was 0.68-0.70.
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