Prognostic implications of serial risk score assessments in patients with pulmonary arterial hypertension: A Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) analysis
Prognostic implications of serial risk score assessments in patients with pulmonary arterial hypertension: A Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) analysis
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DOI：
10.1016/j.healun.2014.09.016
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发表时间：
2015-03-01
影响因子：
8.9
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：评估早期和长期肺动脉高压疾病管理 (REVEAL) 登记处的数据之前被用来开发风险评分计算器来预测 1 年生存率。我们评估了 12 个月内风险评分和个体风险评分参数变化的预后影响。方法：根据从入组到 12 个月期间风险评分降低、不变或升高对患者进行分组。 Kaplan-Meier 对随后 1 年生存率的估计是根据最初 12 个月随访期间风险评分的变化进行的。使用 Cox 回归进行多变量分析。 结果：在入组后 12 个月时，分析队列中的 2,529 名患者中，800 名患者的风险评分下降，959 名患者的风险评分保持不变，770 名患者的风险评分增加。六个参数（基础等级、收缩压、心率、6 分钟步行距离、脑钠肽水平和心包积液）随着时间的推移，每一个参数都会发生充分的变化，以改善或恶化≥ 5% 患者的风险评分。对于 12 个月时风险评分降低、不变和升高的患者，下一年的一年生存率估计分别为 93.7%、90.3% 和 84.6%。风险评分的变化可显着预测未来的生存率，并根据入组时的风险进行调整。同时考虑随访风险和入组风险，尽管入组风险对未来生存率保持显着影响，但随访风险是一个更强的预测因子。结论：大多数肺动脉高压患者在 12 个月内都会出现 REVEAL 风险评分的变化，并且可以预测生存。因此，系列风险评分评估可以识别疾病轨迹的变化，从而可能需要调整治疗。 (C) 2015 年国际心肺移植学会。版权所有。
BACKGROUND: Data from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) were used previously to develop a risk score calculator to predict 1-year survival. We evaluated prognostic implications of changes in the risk score and individual risk-score parameters over 12 months.METHODS: Patients were grouped by decreased, unchanged, or increased risk score from enrollment to 12 months. Kaplan-Meier estimates of subsequent 1-year survival were made based on change in the risk score during the initial 12 months of follow-up. Cox regression was used for multivariable analysis.RESULTS: Of 2,529 patients in the analysis cohort, the risk score was decreased in 800, unchanged in 959, and increased in 770 at 12 months post-enrollment. Six parameters (fundtional class, systolic blood pressure, heart rate, 6-minute walk distance, brain natriuretic peptide levels, and pericardial effusion) each changed sufficiently over time to improve or worsen risk scores in >= 5% of patients. One-year survival estimates in the subsequent year were 93.7%, 90.3%, and 84.6% in patients with a decreased, unchanged, and increased risk score at 12 months, respectively. Change in risk score significantly predicted future survival, adjusting for risk at enrollment. Considering follow-up risk concurrently with risk at enrollment, follow-up risk was a much stronger predictor, although risk at enrollment maintained a significant effect on future survival.CONCLUSIONS: Changes in REVEAL risk scores occur in most patients with pulmonary arterial hypertension over a 12-month period and are predictive of survival. Thus, serial risk score assessments can identify changes in disease trajectory that may warrant treatment modifications. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.