Idiopathic Pulmonary Fibrosis (IPF) is a chronic and progressive form of interstitial lung disease characterized by inflammation and abnormal tissue repair ultimately leading to decreased pulmonary function and death. Risk factors for IPF are largely unknown and medical treatment offers a poor prognosis due to the lack of effective treatment options.
Survival outcomes were analyzed for a cohort of 331 patients. The median age at clinical evaluation for IPF was 69 years. Subjects survived an average of 21.82 months after diagnosis, with a higher survival in females than in males. Males had a risk 2.85 times higher than females of death. Subjects older than 69 years of age had a relative risk of dying of 1.6 in comparison to subjects younger than 69 years.
Predictors of survival after lung transplant were also analyzed in a cohort of 990 lung transplanted patients. The overall survival was 41.6%, (41.5 % in males, and 41.8 % in females), the average length of the follow up was 45.84 plus or minus 51.98 months (range 0 to 282.47 months). Females tend to live longer than males: 50.75 plus or minus 55.41 months versus 40.64 plus or minus 47.60 months, respectively. Males had a risk of dying during the follow up that was 1.18 (95% CI 1.01-1.40) relative to females, after adjusting for ethnicity, age, smoking status, diagnosis and donor characteristics. Females who had at least one full term pregnancy during their life had better survival rates than females who had no full term pregnancies.
Our results of a better survival after lung transplant in females (particularly females with at least one pregnancy) support the hypothesis of a hormonal contribution to survival and of the development of immunotolerance after pregnancy.
The public health significance includes the use of the current study as a model in understanding the role of immunity in cancer development. The age-adjusted incidence rate is 555.8 per 100,000 men and 411.3 per 100,000 women per year (2000-2004), and the combined lifetime risk of cancer is approximately 1 in 2. Thus, any further understanding of cancer causes would be worthwhile in cancer prevention and treatment efforts.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-11122007-142259 |
| Date | 30 January 2008 |
| Creators | Creel, Michael Eric |
| Contributors | Joseph Schwerha, MD, MPH, Jay Harper, MD, MPH, Luis Ortiz, MD, Emanuela Taoli, MD, PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-11122007-142259/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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