Key result
Higher carbon monoxide diffusion capacity (DLCO) was significantly associated with improved transplant-free survival (HR 0.939) in patients with precapillary pulmonary hypertension.
Why the study?
DLCO is associated with survival in idiopathic PH but is not included in the 2015 European guideline risk stratification score, prompting evaluation of its association with PH severity and survival.
Does baseline carbon monoxide diffusion capacity (DLCO) predict transplant-free survival in treatment-naive patients with precapillary pulmonary hypertension?
Cohort (n=85)
No
Does baseline carbon monoxide diffusion capacity (DLCO) predict transplant-free survival in treatment-naive patients with precapillary pulmonary hypertension?
Hazard Ratio: 0.939 (95% CI 0.908–0.971)
p-value: p=< 0.001
Baseline DLCO is an independent prognostic marker for transplant-free survival in precapillary pulmonary hypertension, and its inclusion improves contemporary risk stratification scores.
Carbon monoxide diffusion capacity (DLCO) is negatively associated with patient survival in idiopathic pulmonary hypertension (PH), but is not included in the risk stratification score proposed by the 2015 European guidelines. Since 2015, several new stratification scores based on a 3- or 4-severity scale have been explored. This retrospective cohort single-center study sought to investigate the association between DLCO and PH severity and survival. We included 85 treatment-naive patients with precapillary PH and DLCO measurement at diagnosis. DLCO status, based on lower and upper quartiles ranges, was added to a 3- and a 4-strata modified-risk assessment. DLCO was strongly associated with transplant-free survival (HR 0.939, 95% CI: 0.908–0.971, p < 0.001). In the intermediate and high-risk categories, DLCO was associated with transplant-free survival, irrespective of the risk category (HR 0.934, 95% CI: 0.880–0.980, p = 0.005). The correlation between modified-risk category and transplant-free survival was significant (HR 4.60, 95% CI: 1.294–16.352, p = 0.018). Based on the Akaike information criterion (AIC) levels, the 3- and 4-strata modified-risk stratification fits our results better than the conventional stratification. Low DLCO is associated with patient transplant-free survival, independently of the risk category. Inclusion of DLCO into a PH risk stratification score seems promising and needs further investigation.
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Diamanti et al. (2021) conducted a cohort in Precapillary pulmonary hypertension (n=85). Carbon monoxide diffusion capacity (DLCO) was evaluated on Transplant-free survival (HR 0.939, 95% CI 0.908-0.971, p=< 0.001). Higher carbon monoxide diffusion capacity (DLCO) was significantly associated with improved transplant-free survival (HR 0.939) in patients with precapillary pulmonary hypertension.
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