Torvan Versus Gap: Which Performs Better?

Introduction: Idiopathic pulmonary fibrosis(IPF) is a progressive disease with a worse prognosis. The gender-age-physiology (GAP) index is widely used as predictor of mortality in clinical practice. Recently, the TORVAN index,which also takes into account comorbidities,has been proposed as alternative.The aim of ourstudy was to compare the performance of the two indices in a real life setting in a cohort of IPF patients treated with pirfenidone or nintedanib. Materials and Methods: The clinical charts of IPF patients referring to the Units of Respiratory Disease of the University hospitals of Foggia and Naples (Federico II) between 2007 and 2019 were retrospectively reviewed. Patients were stratified into three and four groups with reference to the GAP and TORVAN indices, respectively. The Kaplan-Meyer survival curves were then reconstructed Results: The study included 271 patients (202 M): a mean age of 69yrs (±9.2); FVC 77.2± 21.2% and DLCO 49.8.9±14.9%. As shown in the graph below, the GAP and TORVAN indices stratified the patients population in a quite similar manner with a overall median survival of 45.9 months. However, the TORVAN allowed the identification of a subset of patients with a better survival that was not at all detected by the GAP. Conclusions: This finding confirms that, apart from lung function, early and proper recognition of comorbidities has an additional value in predicting disease behavior in IPF patients.