title: Performance of the REVEAL model in WHO Group 2 to 5 pulmonary hypertension: application beyond pulmonary arterial hypertension.
abstract: BACKGROUND
  The majority of patients with pulmonary hypertension (PH) have non-pulmonary arterial hypertension PH (non-PAH PH) or multifactorial PH. The REVEAL score was designed to predict 1-year survival in patients with pulmonary arterial hypertension (PAH) only. It is unknown whether this model is applicable to a more general population of PH patients.
  
  
  METHODS
  Both newly diagnosed and previously diagnosed patients with PH of any etiology (n = 200) were enrolled in an observational cohort between the years 2003 and 2009. REVEAL scores were assessed for the ability to predict 1-year survival in the following groups: (1) PAH; (2) non-PAH PH; (3) multifactorial PH; and (4) the entire cohort.
  
  
  RESULTS
  Of the 200 patients, 126 (63%) had PAH, 32 (16%) had non-PAH PH and 42 (21%) had multifactorial PH. The concordance indices for the model when applied to the various groups were: PAH, 0.72; non-PAH PH, 0.97; multifactorial PH, 0.77; and entire cohort, 0.775. Observed and predicted survivals of the entire cohort according to model-assigned risk strata were not statistically different from one another (p = 0.60), suggesting adequate model calibration.
  
  
  CONCLUSIONS
  The REVEAL survival prediction model for PAH has comparable performance when applied to a broad population of PH patients. The data suggest that the model may have utility in PH patients in general, subject to validation in a larger cohort.
authors.affiliation: Division of Cardiology, University of California, San Francisco, San Francisco, CA 94117, USA. rebecca.cogswell@ucsf.edu
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cogswell
authors.forename: Dana
authors.initials: D
authors.lastname: McGlothlin
authors.forename: Erin
authors.initials: E
authors.lastname: Kobashigawa
authors.forename: Robin
authors.initials: R
authors.lastname: Shaw
authors.forename: Teresa
authors.initials: T
authors.lastname: De Marco
mesh_terms: D015331:Cohort Studies; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014944:World Health Organization