Shameek Gayen, Jay Pescatore, Matthew Bittner, Mario Naranjo, Gerard J Criner, Sheila Weaver
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引用次数: 0
摘要
背景:肺动脉高压(PH)会增加慢性肺病患者的死亡率,但仍然缺乏有效的风险评估工具来预测这些患者的预后。我们的目的是创建一种风险评估工具,通过从PH诊断时开始的一年死亡风险对慢性肺部疾病和PH患者进行分层。方法:这是一项针对慢性肺部疾病和ph患者的回顾性队列研究。我们通过多变量Cox回归确定了一年死亡率的预测因素,并根据风险比为确定的预测因素分配了点值,以构成风险评分。根据总分将患者分为低、中、高风险三组。对分层组进行Kaplan-Meier生存分析比较。内部统计验证通过Cox回归与bootstrapping。结果:构成我们的风险评估工具的一年死亡率的确定预测因素是肺纤维化无肺气肿,肺血管阻力bbbb5 WU, 6分钟步行距离200 pg/mL,年龄b> 65岁(PVD-B65)。一旦将患者分为三个危险组,Kaplan-Meier生存分析显示亚组之间的一年生存率存在显著差异(logrank p = 0.002)。结论:PVD-B65风险评估工具是一种新型的,内部验证的慢性肺部疾病和PH患者一年死亡率风险计算器,包括与肺实质和血管重构相关的因素。它可能有助于对慢性肺部疾病和PH患者进行风险分层和指导治疗干预。
Development of the pulmonary fibrosis, pulmonary vascular resistance, six minute walk distance, B-type natriuretic peptide, age (PVD-B65) risk score for patients with chronic lung disease and pulmonary hypertension.
Background: Pulmonary hypertension (PH) confers increased mortality in patients with chronic lung disease, yet there remains a lack of validated risk assessment tools to prognosticate these patients. We aimed to create a risk assessment tool to stratify patients with chronic lung disease and PH by risk of one-year mortality from time of PH diagnosis.
Methods: This was a retrospective cohort study of patients with chronic lung disease and PH. We identified predictors of one-year mortality via multivariable Cox regression and assigned point values to the identified predictors based on their hazard ratios to comprise the risk score. Patients were stratified into low, intermediate, and high-risk based on total scores. Kaplan-Meier survival analysis comparing the stratified groups was performed. Internal statistical validation was performed via Cox regression with bootstrapping.
Results: The identified predictors of one-year mortality that comprised our risk assessment tool were pulmonary fibrosis without emphysema, pulmonary vascular resistance > 5 WU, six-minute walk distance < 150 m, BNP > 200 pg/mL, and age > 65 years (PVD-B65). Once patients were stratified into the three risk groups, Kaplan-Meier survival analysis demonstrated significant differences in one-year survival between the subgroups (logrank p = 0.002). The risk assessment model demonstrated internal validation via bootstrapping (p < 0.05).
Conclusion: The PVD-B65 risk assessment tool is a novel, internally validated one-year mortality risk calculator for patients with chronic lung disease and PH that encompasses factors related to pulmonary parenchymal and vascular remodeling. It may help risk stratify and guide therapeutic interventions in patients with chronic lung disease and PH.
期刊介绍:
BMC Pulmonary Medicine is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.