Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA.
Department of Medicine, Section of Cardiology, University of Chicago Medical Center, Chicago, IL.
Chest. 2012 Feb;141(2):354-362. doi: 10.1378/chest.11-0676. Epub 2011 Jun 16.
In pulmonary arterial hypertension (PAH), survival predictions can be important for optimization of therapeutic strategies. The present study aimed to validate a quantitative algorithm for predicting survival derived from the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry) and develop a simplified calculator for everyday clinical use.
Prospectively collected data from patients with newly diagnosed (< 3 months) World Health Organization group I pulmonary hypertension enrolled in the REVEAL Registry were used to validate a predictive algorithm for 1-year survival. Model calibration was evaluated by comparing algorithm-predicted survival with observed Kaplan-Meier estimates for the overall validation cohort and for five risk groups. Similarly, the risk discriminators for the simplified calculator were compared with those of the quantitative algorithm.
The validation cohort comprised 504 individuals with mean ± SD 6-min walk distance 308 ± 128 m, and 61.5% were functional class III. The proportion of patients surviving 1 year fell within the range predicted by the model (95.1%, 91.5%, 84.6%, 76.3%, and 58.2%, respectively) among patients in the low (predicted survival ≥ 95%), average (90% to < 95%), moderate (85% to < 90%), high (70% to < 85%), and very high (< 70%) risk strata. Predicted and observed 1-year survival were similar across risk stratum, and the c-index indicated good discrimination for both the full equation (0.726) and the simplified risk calculator (0.724).
The REVEAL Registry predictive algorithm and simplified risk score calculator are well calibrated and demonstrate good discriminatory ability in patients with newly or previously diagnosed PAH.
ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov.
在肺动脉高压（PAH）中，生存预测对于优化治疗策略非常重要。本研究旨在验证一种源自评估早期和长期 PAH 疾病管理登记研究（REVEAL 登记研究）的预测生存的定量算法，并开发一种简化的计算器，用于日常临床使用。
使用来自新诊断（<3 个月）世界卫生组织 I 组肺动脉高压患者的前瞻性登记数据，验证用于预测 1 年生存率的预测算法。通过将算法预测的生存率与整个验证队列和五个风险组的观察性 Kaplan-Meier 估计进行比较，评估模型校准。同样，简化计算器的风险判别器与定量算法的风险判别器进行了比较。
验证队列包括 504 名患者，平均（标准差）6 分钟步行距离为 308（128）m，61.5%为功能分级 III。模型预测的 1 年生存率范围内的患者比例（95.1%、91.5%、84.6%、76.3%和 58.2%）与低风险（预测生存率≥95%）、平均风险（90%至<95%）、中度风险（85%至<90%）、高风险（70%至<85%）和极高风险（<70%）风险分层的患者相符。在风险分层中，预测和观察到的 1 年生存率相似，C 指数表明，全方程（0.726）和简化风险计算器（0.724）均具有良好的判别能力。
REVEAL 登记研究预测算法和简化风险评分计算器在新诊断或既往诊断的 PAH 患者中具有良好的校准和判别能力。
ClinicalTrials.gov；编号：NCT00370214；网址：www.clinicaltrials.gov。
