Analysis of the Lung Allocation Score Estimation of Risk of Death in Patients With Pulmonary Arterial Hypertension Using Data From the REVEAL Registry
Analysis of the Lung Allocation Score Estimation of Risk of Death in Patients With Pulmonary Arterial Hypertension Using Data From the REVEAL Registry
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DOI：
10.1097/tp.0b013e3181e49b83
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发表时间：
2010-08-15
期刊：
影响因子：
6.2
通讯作者：
McGoon, Michael D.
中科院分区：
文献类型：
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作者：
Benza, Raymond L.;Miller, Dave P.;McGoon, Michael D.
背景肺分配评分（LAS）实施后，肺动脉高压（PAH）患者的候补死亡率并未改善。我们分析了登记研究中患者的数据，以评估早期和长期PAH疾病管理（REVEAL），作为比较观察到的死亡率与LAS预测死亡率的一种手段，以确定可能纳入LAS的关键预后参数，以改善PAH患者的等待名单死亡率。在入组REVEAL的2967例PAH患者中，2327例具有计算LAS所需的所有变量。进行单变量和多变量分析，比较LAS公式预测的等待名单生存率与REVEAL队列观察到的生存率。在使用考克斯比例风险模型的多变量分析中，与LAS预测的死亡率相比，两个变量与死亡率增加独立相关：平均右心房压（mRAP）≥ 14 mm Hg和6分钟步行试验距离（6-MWD）≤ 300 m。开发了一种改进的LAS系统，将计算的等待列表生存分量更新如下：修改的等待列表指数等于原始等待列表指数加0.7;如果mRAP大于或等于14 mm Hg，则减0.35;对于每100 m的6-MWD，加1.0。在最初的3年试验期后，每6个月对LAS进行一次重新评估。我们的研究结果表明，包括6-MWD和mRAP的LAS模型比当前LAS更好地区分PAH患者的等待名单紧迫性。
Background. Waitlist mortality for patients with pulmonary arterial hypertension (PAH) has not improved after implementation of the lung allocation score (LAS). We analyzed data from patients in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) as a means to compare observed mortality with predicted mortality from the LAS to identify key prognostic parameters that may be incorporated into the LAS to improve waitlist mortality for patients with PAH.Methods. Of the 2967 patients with PAH enrolled in REVEAL, 2327 had all required variables available to compute the LAS. Univariable and multivariable analyses were conducted to compare waitlist survival predicted by the LAS formula with that observed in the REVEAL cohort.Results. Two variables were independently associated with increased mortality compared with that predicted by the LAS in multivariable analysis using a Cox proportional hazards model: mean right atrial pressure (mRAP) more than or equal to 14 mm Hg and 6-min walk test distance (6-MWD) less than or equal to 300 m. A modified LAS system was developed, updating the waitlist survival component of the calculation as follows: modified waitlist exponent equals original waitlist exponent plus 0.7; if mRAP is more than or equal to 14 mm Hg, minus 0.35; for every 100 m of 6-MWD, plus 1.0.Conclusions. The LAS is reevaluated every 6 months after the initial 3-year trial period. Our results suggest that an LAS model that includes both 6-MWD and mRAP better discriminates waitlist urgency for patients with PAH than the current LAS.