Photo Credit: Rasi Bhadramani
The following is a summary of “A comparative analysis of risk stratification tools in systemic sclerosis-associated pulmonary arterial hypertension: a EUSTAR analysis,” published in the January 2025 issue of Rheumatology by Bjørkekjær et al.
The 2022 European Society of Cardiology and European Respiratory Society (ESC/ERS) Guidelines recommend risk stratification for PAH management. Its effectiveness in systemic sclerosis (SSc)-PAH remains unclear.
Researchers conducted a retrospective study to identify the most accurate risk stratification approach for SSc-PAH diagnosis.
They screened 11 risk stratification tools upon SSc-PAH diagnosis using the European Scleroderma Trials and Research (EUSTAR) group database. They compared the top 3 tools’ performance to predict mortality with the ESC/ERS 3-strata model. The impact of incorporating SSc-specific characteristics was assessed. Kaplan-Meier analyses and Cox regression with area under the ROC curve (AUC) were conducted.
The results showed the ESC/ERS 3-strata model had lower mortality prediction ability than the ESC/ERS 4-strata model, “SPAHR updated,” and “REVEAL Lite 2.” The ESC/ERS 4-strata model divided patients with “intermediate-risk” into 2 groups with significantly different survival rates and was the easiest applicable tool. Incorporating SSc-specific characteristics did not improve model prediction, but a low DLCO was an independent predictor of mortality.
Investigators recommended using the simplified ESC/ERS 4-strata model at SSc-PAH diagnosis as an alternative to the comprehensive ESC/ERS 3-strata model. They also proposed considering DLCO as an individual prognostic marker in SSc-PAH.
Source: academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keaf053/7989309
