Pulmonary hypertension (PH) is a heterogeneous disease with a poor prognosis. Accurate risk stratification is essential for guiding treatment decisions in pulmonary arterial hypertension (PAH). Although various risk models have been developed for PAH, their comparative prognostic potential requires further exploration. Additionally, the applicability of risk scores in PH groups beyond group 1 remains to be investigated. Are risk scores originally developed for PAH predictive in PH groups 1 through 4? We conducted a comprehensive analysis of outcomes among patients with incident PH enrolled in the multicenter worldwide Pulmonary Vascular Research Institute GoDeep meta-registry. Analyses were performed across PH groups 1 through 4 and further subgroups to evaluate the predictive value of PAH risk scores, including REVEAL Lite 2, REVEAL 2.0, ESC/ERS 2022, COMPERA 3-strata, and COMPERA 4-strata. Eight thousand five hundred sixty-five patients were included in the study, of whom 3,537 patients were assigned to group 1 PH, whereas 1,807 patients, 1,635 patients, and 1,586 patients were assigned to group 2 PH, group 3 PH, and group 4 PH, respectively. Pulmonary hemodynamics were impaired with median mean pulmonary arterial pressure of 42 mm Hg (33-52 mm Hg) and pulmonary vascular resistance of 7 WU (4-11 WU). All risk scores were prognostic in the entire PH population and in each of the PH groups 1 through 4. The REVEAL scores, when used as continuous prediction models, demonstrated the highest statistical prognostic power and granularity; the COMPERA 4-strata risk score provided subdifferentiation of the intermediate-risk group. Similar results were obtained when separately analyzing various subgroups (PH subgroups 1.1, 1.4.1, and 1.4.4; PH subgroups 3.1 and 3.2; group 2 with isolated postcapillary PH vs combined precapillary and postcapillary PH; patients of all groups with concomitant cardiac comorbidities; and severe [> 5 WU] vs nonsevere PH). This comprehensive study with real-world data from 15 PH centers showed that PAH-designed risk scores possess predictive power in a large PH cohort, whether considered as common to the group or calculated separately for each PH group (1-4) and various subgroups.

中文翻译：

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所有肺动脉高压组当代风险评分的比较：肺血管研究所 GoDeep 元注册分析

肺动脉高压（PH）是一种预后不良的异质性疾病。准确的风险分层对于指导肺动脉高压（PAH）的治疗决策至关重要。尽管针对 PAH 开发了各种风险模型，但它们的比较预后潜力需要进一步探索。此外，风险评分在第 1 组以外的 PH 组中的适用性仍有待研究。风险评分最初是为 PH 组 1 至 4 中的 PAH 预测而开发的吗？我们对全球多中心肺血管研究所 GoDeep 元注册中心登记的突发肺动脉高压患者的结果进行了全面分析。对 PH 组 1 至 4 以及更多亚组进行分析，以评估 PAH 风险评分的预测价值，包括 REVEAL Lite 2、REVEAL 2.0、ESC/ERS 2022、COMPERA 3-strata 和 COMPERA 4-strata。该研究纳入了 8565 名患者，其中 3,537 名患者被分配到 PH 1 组，而 1,807 名患者、1,635 名患者和 1,586 名患者被分配到 PH 2 组、PH 3 组和PH 4 组， 分别。肺血流动力学受损，中位平均肺动脉压为 42 mm Hg (33-52 mm Hg)，肺血管阻力为 7 WU (4-11 WU)。所有风险评分在整个 PH 人群以及每个 PH 组 1 至 4 中均具有预后意义。当用作连续预测模型时，REVEAL 评分表现出最高的统计预后能力和粒度； COMPERA 4 层风险评分提供了中等风险组的亚分化。单独分析各个亚组（PH 亚组 1.1、1.4.1 和 1.4.4；PH 亚组 3.1 和 3.2；单独的毛细血管后 PH 与毛细血管前和毛细血管后 PH 合并的第 2 组；所有组中伴有心脏合并症的患者）时，获得了相似的结果；以及严重 [> 5 WU] 与非严重 PH）。这项综合研究使用来自 15 个 PH 中心的真实世界数据表明，PAH 设计的风险评分在大型 PH 队列中具有预测能力，无论是被认为是该组共有的还是针对每个 PH 组 (1-4) 和各个亚组单独计算。