REVEAL注册研究中初诊肺动脉高压患者首次住院情况的特征分析
Characterization of first-time hospitalizations in patients with newly diagnosed pulmonary arterial hypertension in the REVEAL registry.
作者信息
Burger Charles D, Long Pamela K, Shah Monarch R, McGoon Michael D, Miller Dave P, Romero Alain J, Benton Wade W, Safford Robert E
机构信息
From the Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL.
Department of Clinical Research, Mayo Clinic, Jacksonville, FL.
出版信息
Chest. 2014 Nov;146(5):1263-1273. doi: 10.1378/chest.14-0193.
BACKGROUND
Hospitalization is an important outcome in pulmonary arterial hypertension (PAH), shown previously to correlate with survival. Using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry), we sought to characterize first-time hospitalizations and their effect on subsequent hospitalization and survival in patients with newly diagnosed disease.
METHODS
Patients with newly diagnosed PAH (n = 862, World Health Organization group 1) were evaluated for first-time hospitalization. The hospitalizations were categorized as PAH related or PAH unrelated based on the case report form. Categories for PAH-related and PAH-unrelated hospitalization were defined before independent review. Patient demographics and disease characteristics are described as well as freedom from hospitalization and survival.
RESULTS
Of 862 patients, 490 (56.8%) had one or more hospitalizations postenrollment: 257 (52.4%) PAH related, 214 (43.7%) PAH unrelated, and 19 (3.9%) of undetermined causes. The most common causes of PAH-related hospitalization were congestive heart failure and placement/removal of a central venous catheter. Patients with PAH-related hospitalizations were more likely to receive parenteral therapy, be in functional class III/IV, and have higher risk scores before hospitalization at enrollment. Following discharge, 25.4% ± 3.2% and 31.0% ± 4.0% of patients with PAH-related and PAH-unrelated first hospitalization, respectively, remained hospitalization-free for 3 years (P = .11). Survival estimates at 3 years postdischarge were 56.8% ± 3.5% and 67.8% ± 3.6% (P = .037) for patients with PAH-related and PAH-unrelated hospitalization, respectively.
CONCLUSIONS
In the REVEAL Registry, PAH-related hospitalization was associated with relatively more rehospitalizations and worse survival at 3 years.
TRIAL REGISTRY
ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov.
背景
住院治疗是肺动脉高压（PAH）的一项重要预后指标，先前研究表明其与生存率相关。利用评估PAH疾病早期和长期管理的注册研究（REVEAL注册研究），我们旨在描述初发住院情况及其对新诊断疾病患者后续住院治疗和生存的影响。
方法
对新诊断PAH的患者（n = 862，世界卫生组织第1组）进行初发住院情况评估。根据病例报告表将住院情况分为PAH相关或PAH不相关。在独立审查之前定义PAH相关和PAH不相关住院的类别。描述患者的人口统计学和疾病特征以及无住院情况和生存率。
结果
862例患者中，490例（56.8%）在入组后有一次或多次住院：257例（52.4%）与PAH相关，214例（43.7%）与PAH不相关，19例（3.9%）病因不明。PAH相关住院的最常见原因是充血性心力衰竭和中心静脉导管的置入/拔除。与PAH相关住院的患者更有可能接受肠外治疗，处于功能分级III/IV级，且在入组时住院前风险评分更高。出院后，首次PAH相关和PAH不相关住院的患者分别有25.4%±3.2%和31.0%±4.0%在3年内未再住院（P = 0.11）。出院后3年，PAH相关和PAH不相关住院患者的生存估计分别为56.8%±3.5%和67.8%±3.6%（P = 0.037）。
结论
在REVEAL注册研究中，PAH相关住院与相对更多的再次住院和3年时较差的生存率相关。
试验注册
ClinicalTrials.gov；编号：NCT00370214；网址：www.clinicaltrials.gov。
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