Justin K Lui, Kari R Gillmeyer, Ruchika A Sangani, Robert J Smyth, Deepa M Gopal, Marcin A Trojanowski, Andreea M Bujor, Renda Soylemez Wiener, Michael P LaValley, Elizabeth S Klings
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引用次数: 0
摘要
我们设计了一个评分系统来识别有肺动脉高压(PH)风险的系统性硬化症(SSc)患者,并预测全因死亡率。通过肺功能测试、超声心动图和胸部计算机断层扫描成像获得7个变量,我们将评分应用于117例SSc患者的回顾性队列。经右心导管诊断为PH 60例(51.3%)。使用评分阈值≥0,我们的决策工具预测PH的灵敏度、特异性和准确性分别为0.87 (95% CI 0.75, 0.94)、0.74 (95% CI 0.60, 0.84)和0.80 (95% CI 0.72, 0.87)。当对PH诊断时的年龄、性别和接受肺动脉血管扩张剂进行校正后,每增加1分,全因死亡率校正后的HR为1.19 (95% CI 1.05, 1.34)。通过外部队列的进一步验证,我们简化的临床决策工具可以更好地简化SSc中PH的早期检测。
A Clinical Decision Tool for Risk Stratifying Patients with Systemic Sclerosis-Related Pulmonary Hypertension.
We devised a scoring system to identify patients with systemic sclerosis (SSc) at risk for pulmonary hypertension (PH) and predict all-cause mortality. Using 7 variables obtained via pulmonary function testing, echocardiography, and computed tomographic chest imaging, we applied the score to a retrospective cohort of 117 patients with SSc. There were 60 (51.3%) who were diagnosed with PH by right heart catheterization. Using a scoring threshold ≥ 0, our decision tool predicted PH with a sensitivity, specificity, and accuracy of 0.87 (95% CI 0.75, 0.94), 0.74 (95% CI 0.60, 0.84), and 0.80 (95% CI 0.72, 0.87), respectively. When adjusted for age at PH diagnosis, sex, and receipt of pulmonary arterial vasodilators, each one-point score increase was associated with an adjusted HR of 1.19 (95% CI 1.05, 1.34) for all-cause mortality. With further validation in external cohorts, our simplified clinical decision tool may better streamline earlier detection of PH in SSc.
期刊介绍:
Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.