Ayşegül ERİNÇ, Ali KIRAÇ, Şule GÜL, Erdoğan ÇETİNKAYA
Comprehensive Medicine - 2026;18(3):266-272
Objective: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease associated with substantial morbidity and mortality. The GAP (Gender-Age-Physiology) index is widely used for prognostic stratification; however, it does not incorporate cardiovascular parameters. The incremental prognostic value of echocardiographic systolic pulmonary artery pressure (sPAP) beyond the GAP index remains unclear. Materials and Methods: This retrospective, single-center cohort study included 114 patients diagnosed with IPF. The GAP index was calculated for all patients, and systolic pulmonary artery pressure was estimated using transthoracic echocardiography. Overall survival was analyzed using Cox proportional hazards regression models. The prognostic performance of the GAP index was compared with models incorporating echocardiographic systolic pulmonary artery pressure. Results: A total of 114 patients with IPF were included (median age: 63 years; 73.3% male). During follow-up, 66 patients (57.9%) died. The GAP index was significantly associated with mortality in both univariate (HR: 1.29, 95% CI: 1.02-1.64, p=0.034) and multivariate analyses (HR: 1.29, 95% CI: 1.02-1.64, p=0.038). Echocardiographically estimated sPAP was not independently associated with survival, and the addition of sPAP to the GAP model did not significantly improve prognostic discrimination. Conclusion: The GAP index remains a robust predictor of mortality in patients with idiopathic pulmonary fibrosis. Echocardiographic systolic pulmonary artery pressure was not independently associated with survival and did not provide incremental prognostic value beyond established physiological indices. These findings suggest that single-time-point echocardiographic assessment of pulmonary artery pressure may have limited utility for mortality prediction in IPF.
