; Pausch, Christine ; Olsson, Karen M. ; Huscher, Doerte
; Pittrow, David ; Grünig, 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-Jürgen ; Held, Matthias ; Dumitrescu, Daniel ; Tsangaris, Iraklis ; Vonk-Noordegraaf, Anton ; Ulrich, Silvia ; Klose, Hans ; Claussen, Martin ; Lange, Tobias J. ; Rosenkranz, Stephan | Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | European Respiratory Journal | ||||
| Publisher: | EUROPEAN RESPIRATORY SOC JOURNALS LTD | ||||
| Place of Publication: | SHEFFIELD | ||||
| Volume: | 60 | ||||
| Number of Issue or Book Chapter: | 1 | ||||
| Page Range: | p. 2102311 | ||||
| Date: | 2021 | ||||
| Institutions: | Medicine > Lehrstuhl für Innere Medizin II | ||||
| Identification Number: |
| ||||
| Keywords: | SCORE CALCULATOR; SURVIVAL; REGISTRY; | ||||
| Dewey Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 57779 |
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 ...

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.
Metadata last modified: 29 Feb 2024 13:02
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