Benza et al reported an updated REVEAL score for predicting survival in a patient with pulmonary arterial hypertension (PAH). This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in the United States.
Patient selection: pulmonary arterial hypertension
Parameters:
(1) WHO Group I subgroup
(2) demographics
(3) comorbidities
(4) NYHA/WHO functional class
(5) vital signs (systolic blood pressure, heart rate)
(6) all-cause hospitalizations in last 6 months
(7) 6-minute walking distance in meters
(8) serum BNP or NT-proBNP
(9) pericardial effusion on echocardiogram
(10) pulmonary function test
(11) mean pulmonary artery pressure (mRAP) by right heart catheterization in mm Hg within 1 year
(12) pulmonary vascular resistance (PVR) by right heart catheterization in Wood units
Parameter |
Finding |
Points |
WHO Group I subgroup |
CTD PAH (PAH with connective tissue disease) |
1 |
|
PoPH (PAH associated with portopulmonary hypertension) |
3 |
|
hereditary |
2 |
|
other |
0 |
demographics |
male and > 60 years of age |
2 |
|
other |
0 |
comorbidities |
eGFR < 60 in mL per min per 1.73 square meter |
1 |
|
renal insufficiency |
1 |
|
other |
0 |
NYHA/ WHO |
I |
-1 |
|
II |
0 |
|
III |
1 |
|
IV |
2 |
systolic blood pressure |
< 110 mm Hg |
1 |
|
>= 110 mm Hg |
0 |
heart rate |
<= 96 beats per minute |
0 |
|
> 96 beats per minute |
1 |
all-cause hospitalizations |
0 |
0 |
|
>= 1 |
1 |
6-minute walking distance |
>= 440 meters |
-2 |
|
320 to 439.9 meters |
-1 |
|
165 to 319.9 meters |
0 |
|
< 165 meters |
1 |
serum natriuretic peptide |
BNP < 50 pg/mL |
-2 |
|
BNP 50 to 199 |
0 |
|
BNP 200 to 799 |
1 |
|
BNP >= 800 |
2 |
|
NT proBNP < 300 pg/mL |
-2 |
|
NT proBNP 300 to 1,099 |
not given |
|
NT proBNP >= 1,100 |
2 |
pericardial effusion |
no |
0 |
|
yes |
1 |
diffusing capacity CO |
>= 40% of predicted |
0 |
|
< 40% |
1 |
mRAP within 1 year |
<= 20 mm Hg |
0 |
|
> 20 mm Hg |
1 |
PVR |
< 5 Wood units |
-1 |
|
>= 5 Wood units |
0 |
total score =
= SUM(points for all of the parameters) + 6
Interpretation:
• minimum score: 0
• maximum score: 23
• The higher the score the greater the risk of mortality.
Score |
Risk Grup |
1-Year Mortality |
0 to 6 |
low risk |
2% |
7 or 8 |
intermediate risk |
6% |
>= 9 |
high risk |
25-34% |
Performance:
• The area under the ROC curve is 0.76.
Specialty: Pulmonology