Journal article
Authors list: Hoeper, Marius M.; Pausch, Christine; Olsson, Karen M.; Huscher, Doerte; Pittrow, David; Gruenig, Ekkehard; Staehler, Gerd; Vizza, Carmine Dario; Gall, Henning; Distler, Oliver; Opitz, Christian; Gibbs, J. Simon R.; Delcroix, Marion; Ghofrani, H. Ardeschir; Park, Da-Hee; Ewert, Ralf; Kaemmerer, Harald; Kabitz, Hans-Joachim; Skowasch, Dirk; Behr, Juergen; Milger, Katrin; Halank, Michael; Wilkens, Heinrike; Seyfarth, Hans-Juergen; Held, Matthias; Dumitrescu, Daniel; Tsangaris, Iraklis; Vonk-Noordegraaf, Anton; Ulrich, Silvia; Klose, Hans; Claussen, Martin; Lange, Tobias J.; Rosenkranz, Stephan
Publication year: 2022
Journal: European Respiratory Journal
Volume number: 60
Issue number: 1
ISSN: 0903-1936
eISSN: 1399-3003
Open access status: Hybrid
DOI Link: https://doi.org/10.1183/13993003.02311-2021
Publisher: European Respiratory Society
Abstract:
Background Risk stratification plays an essential role in the management of patients with pulmonary arterial hypertension (PAH). The current European guidelines propose a three-stratum model to categorise risk as low, intermediate or high, based on the expected 1-year mortality. However, with this model, most patients are categorised as intermediate risk. We investigated a modified approach based on four risk categories, with intermediate risk subdivided into intermediate-low and intermediate-high risk. Methods We analysed data from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA), a European pulmonary hypertension registry, and calculated risk at diagnosis and first follow-up based on World Health Organization functional class, 6-min walk distance (6MWD) and serum levels of brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP), using refined cut-off values. Survival was assessed using Kaplan-Meier analyses, log-rank testing and Cox proportional hazards models. Results Data from 1655 patients with PAH were analysed. Using the three-stratum model, most patients were classified as intermediate risk (76.0% at baseline and 63.9% at first follow-up). The refined four -stratum risk model yielded a more nuanced separation and predicted long-term survival, especially at follow-up assessment. Changes in risk from baseline to follow-up were observed in 31.1% of the patients with the three-stratum model and in 49.2% with the four-stratum model. These changes, including those between the intermediate-low and intermediate-high strata, were associated with changes in long-term mortality risk. Conclusions Modified risk stratification using a four-stratum model based on refined cut-off levels for functional class, 6MWD and BNP/NT-proBNP was more sensitive to prognostically relevant changes in risk than the original three-stratum model.
Citation Styles
Harvard Citation style: Hoeper, M., Pausch, C., Olsson, K., Huscher, D., Pittrow, D., Gruenig, E., et al. (2022) COMPERA 2.0: a refined four-stratum risk assessment model for pulmonary arterial hypertension, European Respiratory Journal, 60(1), Article 2102311. https://doi.org/10.1183/13993003.02311-2021
APA Citation style: Hoeper, M., Pausch, C., Olsson, K., Huscher, D., Pittrow, D., Gruenig, E., Staehler, G., Vizza, C., Gall, H., Distler, O., Opitz, C., Gibbs, J., Delcroix, M., Ghofrani, H., Park, D., Ewert, R., Kaemmerer, H., Kabitz, H., Skowasch, D., ...Rosenkranz, S. (2022). COMPERA 2.0: a refined four-stratum risk assessment model for pulmonary arterial hypertension. European Respiratory Journal. 60(1), Article 2102311. https://doi.org/10.1183/13993003.02311-2021
Keywords
REGISTRY; SCORE CALCULATOR
