COMPERA 2.0: a refined four-stratum risk assessment model for pulmonary arterial hypertension.
COMPERA 2.0: a refined four-stratum risk assessment model for pulmonary arterial hypertension.
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DOI：
10.1183/13993003.02311-2021
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发表时间：
2022-07
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影响因子：
--
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风险分层在肺动脉高压（PAH）患者的管理中起着至关重要的作用。目前的欧洲指南提出了一个基于1年预期死亡率的三层模型，将风险分为低、中、高。然而，在这种模式下，大多数患者被归类为中度风险。我们研究了一种基于四种风险类别的改进方法，将中等风险细分为中低风险和中高风险。我们分析了来自肺动脉高血压新开始治疗的比较前瞻性登记（COMPERA）的数据，这是一个欧洲肺动脉高血压登记，并根据世界卫生组织功能分类、6分钟步行距离（6MWD）和血清脑钠肽（BNP）或n端亲BNP （NT-proBNP）水平计算诊断和首次随访时的风险，使用精确的临界值。生存率评估采用Kaplan-Meier分析、log-rank检验和Cox比例风险模型。分析了1655例PAH患者的数据。采用三层模型，大多数患者归为中危（基线时为76.0%，首次随访时为63.9%）。精细化的四层风险模型产生了更细致的分离，并预测了长期生存，特别是在后续评估中。从基线到随访，三层模型患者的风险变化为31.1%，四层模型患者的风险变化为49.2%。这些变化，包括中低地层和中高地层之间的变化，与长期死亡风险的变化有关。与原始的三层模型相比，基于功能类别、6MWD和BNP/NT-proBNP的精细化截断水平的四层模型改进的风险分层对与预后相关的风险变化更为敏感。COMPERA 2.0是一种基于功能类别、6MWD和BNP/NT-proBNP的精细化截断水平的四层风险评估模型，与原始的三层模型https://bit.ly/3mzPKjA相比，该模型对风险的预后显著变化更为敏感
Risk stratification plays an essential role in the management of patients with pulmonary arterial hypertension (PAH). The current European guidelines propose a three-stratum model to categorise risk as low, intermediate or high, based on the expected 1-year mortality. However, with this model, most patients are categorised as intermediate risk. We investigated a modified approach based on four risk categories, with intermediate risk subdivided into intermediate-low and intermediate-high risk. We analysed data from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA), a European pulmonary hypertension registry, and calculated risk at diagnosis and first follow-up based on World Health Organization functional class, 6-min walk distance (6MWD) and serum levels of brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP), using refined cut-off values. Survival was assessed using Kaplan–Meier analyses, log-rank testing and Cox proportional hazards models. Data from 1655 patients with PAH were analysed. Using the three-stratum model, most patients were classified as intermediate risk (76.0% at baseline and 63.9% at first follow-up). The refined four-stratum risk model yielded a more nuanced separation and predicted long-term survival, especially at follow-up assessment. Changes in risk from baseline to follow-up were observed in 31.1% of the patients with the three-stratum model and in 49.2% with the four-stratum model. These changes, including those between the intermediate-low and intermediate-high strata, were associated with changes in long-term mortality risk. Modified risk stratification using a four-stratum model based on refined cut-off levels for functional class, 6MWD and BNP/NT-proBNP was more sensitive to prognostically relevant changes in risk than the original three-stratum model. COMPERA 2.0, a four-stratum risk assessment model based on refined cut-off levels for functional class, 6MWD and BNP/NT-proBNP was more sensitive to prognostically significant changes in risk than the original three-stratum model https://bit.ly/3mzPKjA
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影响因子：
8.9
作者：
Hoeper, Marius M.;Pausch, Christine;Held, Matthias
通讯作者：
Held, Matthias
DOI：
10.1164/rccm.201909-1771oc
发表时间：
2020-02-15
影响因子：
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影响因子：
24.3
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Hoeper, Marius M.;Kramer, Tilmann;Gruenig, Ekkehard
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