Development and Validation of an Abridged Version of the REVEAL 2.0 Risk Score Calculator, REVEAL Lite 2, for Use in Patients With Pulmonary Arterial Hypertension
Development and Validation of an Abridged Version of the REVEAL 2.0 Risk Score Calculator, REVEAL Lite 2, for Use in Patients With Pulmonary Arterial Hypertension
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DOI：
10.1016/j.chest.2020.08.2069
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发表时间：
2021-01-06
期刊：
影响因子：
9.6
通讯作者：
Farber, Harrison W.
中科院分区：
文献类型：
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作者：
Benza, Raymond L.;Kanwar, Manreet K.;Farber, Harrison W.
背景：实现低风险状态是肺动脉高压（PAH）的治疗目标。风险评估通常使用多参数工具进行，例如评估早期和长期PAH疾病管理（REVEAL）风险计算器的登记研究。在不影响有效性的情况下评估较少变量的风险计算器可以加快常规临床环境中的风险评估。我们描述了REVEAL Lite 2（REVEAL 2.0的简化版本）的开发和验证。研究问题：是否可以开发和验证用于PAH患者的REVEAL 2.0风险评估计算器的简化版本？研究设计和方法：REVEAL Lite 2包括6个无创变量-功能分类（FC）、生命体征（收缩压[SBP]和心率）、6分钟步行距离（6 MWD）、脑钠肽（BNP）/脑钠肽N末端激素原（NT-proBNP）和肾功能不全（通过估计肾小球滤过率[eGFR]）-并在一系列分析中得到验证结果：REVEAL Lite 2在区分REVEAL登记研究中患者1年死亡率的低、中和高风险方面接近REVEAL 2.0。该模型表明，REVEAL Lite 2最具预测性的参数是BNP/NT-proBNP，其次是6 MWD和FC。即使多个预测性较低的变量（心率、收缩压、eGFR）缺失，REVEAL Lite 2仍能区分风险组。解释：REVEAL Lite 2是REVEAL 2.0的简化版本，提供了一种简化的风险评估方法，可在日常临床实践中常规实施。REVEAL Lite 2是一种强大的工具，可区分1年死亡率低、中和高风险的患者。
BACKGROUND: Achievement of low-risk status is a treatment goal in pulmonary arterial hypertension (PAH). Risk assessment often is performed using multiparameter tools, such as the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk calculator. Risk calculators that assess fewer variables without compromising validity may expedite risk assessment in the routine clinic setting. We describe the development and validation of REVEAL Lite 2, an abridged version of REVEAL 2.0.RESEARCH QUESTION: Can a simplified version of the REVEAL 2.0 risk assessment calculator for patients with PAH be developed and validated?STUDY DESIGN AND METHODS: REVEAL Lite 2 includes six noninvasive variables-functional class (FC), vital signs (systolic BP [SBP] and heart rate), 6-min walk distance (6MWD), brain natriuretic peptide (BNP)/N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and renal insufficiency (by estimated glomerular filtration rate [eGFR])-and was validated in a series of analyses (Kaplan-Meier, concordance index, Cox proportional hazard model, and multivariate analysis).RESULTS: REVEAL Lite 2 approximates REVEAL 2.0 at discriminating low, intermediate, and high risk for 1-year mortality in patients in the REVEAL registry. The model indicated that the most highly predictive REVEAL Lite 2 parameter was BNP/NT-proBNP, followed by 6MWD and FC. Even if multiple, less predictive variables (heart rate, SBP, eGFR) were missing, REVEAL Lite 2 still discriminated among risk groups.INTERPRETATION: REVEAL Lite 2, an abridged version of REVEAL 2.0, provides a simplified method of risk assessment that can be implemented routinely in daily clinical practice. REVEAL Lite 2 is a robust tool that provides discrimination among patients at low, intermediate, and high risk of 1-year mortality.