Ohio State University, Columbus, OH.
Allegheny General Hospital, Pittsburgh, PA.
Chest. 2021 Jan;159(1):337-346. doi: 10.1016/j.chest.2020.08.2069. Epub 2020 Sep 1.
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.
Can a simplified version of the REVEAL 2.0 risk assessment calculator for patients with PAH be developed and validated?
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).
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.
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.
ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov.
实现低危状态是肺动脉高压（PAH）的治疗目标。风险评估通常使用多参数工具进行，如评估早期和长期 PAH 疾病管理的登记处（REVEAL）风险计算器。风险计算器评估较少的变量而不影响有效性，可能会加快常规临床环境中的风险评估。我们描述了 REVEAL Lite 2 的开发和验证，这是 REVEAL 2.0 的一个简化版本。
能否为 PAH 患者开发和验证简化版的 REVEAL 2.0 风险评估计算器？
REVEAL Lite 2 包含六个非侵入性变量-功能分类（FC）、生命体征（收缩压[SBP]和心率）、6 分钟步行距离（6MWD）、脑利钠肽（BNP）/脑利钠肽前体（NT-proBNP）和肾功能不全（通过估计肾小球滤过率[eGFR]）-并在一系列分析中进行了验证（Kaplan-Meier、一致性指数、Cox 比例风险模型和多变量分析）。
REVEAL Lite 2 可在区分 REVEAL 登记处患者 1 年死亡率的低、中、高危方面近似于 REVEAL 2.0。该模型表明，最具预测性的 REVEAL Lite 2 参数是 BNP/NT-proBNP，其次是 6MWD 和 FC。即使缺少多个不太具有预测性的变量（心率、SBP、eGFR），REVEAL Lite 2 仍然可以区分风险组。
REVEAL Lite 2 是 REVEAL 2.0 的一个简化版本，提供了一种简化的风险评估方法，可以在日常临床实践中常规实施。REVEAL Lite 2 是一种强大的工具，可以在 1 年死亡率低、中、高风险的患者之间提供区分。
ClinicalTrials.gov；编号：NCT00370214；网址：www.clinicaltrials.gov。
