COMPERA 2.0: A refined 4-strata risk assessment model for pulmonary arterial hypertension

Author:

Hoeper Marius M.ORCID,Pausch Christine,Olsson Karen M.,Huscher Doerte,Pittrow DavidORCID,Grünig Ekkehard,Staehler Gerd,Vizza Carmine Dario,Gall HenningORCID,Distler Oliver,Opitz Christian,Gibbs J. Simon R.,Delcroix MarionORCID,Ghofrani H. ArdeschirORCID,Park Da-Hee,Ewert Ralf,Kaemmerer Harald,Kabitz Hans-Joachim,Skowasch Dirk,Behr Juergen,Milger KatrinORCID,Halank Michael,Wilkens Heinrike,Seyfarth Hans-Jürgen,Held Matthias,Dumitrescu Daniel,Tsangaris Iraklis,Vonk-Noordegraaf Anton,Ulrich SilviaORCID,Klose Hans,Claussen Martin,Lange Tobias J.,Rosenkranz Stephan

Abstract

BackgroundRisk stratification plays an essential role in the management of patients with pulmonary arterial hypertension (PAH). The current European guidelines propose a 3-strata 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 4 risk categories with intermediate risk subdivided into intermediate-low and intermediate-high risk.MethodsWe analysed data from COMPERA, a European pulmonary hypertension registry, and calculated risk at diagnosis and first follow-up based on functional class (FC), 6 min walking distance (6 MWD) and serum levels of brain natriuretic peptide (BNP) or N-terminal fragment of pro-BNP (NT-proBNP), using refined cut-off values. Survival was assessed with Kaplan-Meier analyses, log-rank testing, and Cox proportional hazards models.ResultsData from 1,655 patients with PAH were analysed. Using the 3-strata model, most patients were classified as intermediate risk (76.0% at baseline and 63.9% at first follow-up). The refined 4-strata 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 3-strata model and in 49.2% with the 4-strata model. These changes, including those between the intermediate-low and intermediate-high strata, were associated with changes in long-term mortality risk.ConclusionsModified risk stratification using a 4-strata model based on refined cut-off levels for FC, 6MWD and BNP/NT-proBNP was more sensitive to prognostically relevant changes in risk than the original 3-strata model.

Publisher

European Respiratory Society (ERS)

Subject

Pulmonary and Respiratory Medicine

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