Risk assessment in pulmonary hypertension based on routinely measured laboratory parameters.

Abstract

BACKGROUND:

γ-glutamyl transferase (GGT), the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, and the neutrophil-to-lymphocyte ratio (NLR) are prognostic biomarkers in several cardiovascular diseases, but their relevance in pulmonary hypertension (PH) is not fully understood. We aimed to assess their prognostic value in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH).

METHODS:

We retrospectively analyzed 731 incident patients with idiopathic PAH or CTEPH who entered the Giessen PH registry during 1993-2019. A risk stratification score based on GGT, AST/ALT ratio, and NLR tertiles was compared with a truncated version of the European Society of Cardiology/European Respiratory Society (ESC/ERS) risk stratification scheme. Associations with survival were evaluated using Kaplan-Meier and Cox regression analyses. External validation was performed in 311 patients with various types of PAH or CTEPH from a second German center.

RESULTS:

GGT levels, AST/ALT, and NLR independently predicted mortality at baseline and during follow-up. The scoring system based on these biomarkers predicted mortality at baseline and during follow-up (both log-rank p < 0.001; hazard ratio [95% confidence interval], high vs low risk: baseline, 7.6 [3.9, 15.0]; follow-up, 13.3 [4.8, 37.1]). Five-year survival of low, intermediate, and high risk groups was 92%, 76%, and 51%, respectively, at baseline and 95%, 78%, and 50%, respectively, during follow-up. Our scoring system showed characteristics comparable to the ESC/ERS scheme, and predicted mortality in the validation cohort.

CONCLUSION:

GGT, AST/ALT, and NLR were reliable prognostic biomarkers at baseline and during follow-up, with predictive power comparable to the gold standard for risk stratification.

• Authors: Athiththan Yogeswaran, Khodr Tello, Jonas Lund, Hans Klose, Lars Harbaum, Natascha Sommer, Tim Oqueka, Jan K Hennigs, Friedrich Grimminger, Werner Seeger, Hossein Ardeschir Ghofrani, Manuel J Richter, Henning Gall
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 41 Issue 3 Pg. 400-410 (03 2022) ISSN: 1557-3117 [Electronic] United States
• PMID: 34857454 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers

Topics

• Adult
• Aged
• Biomarkers (blood)
• Chronic Disease
• Familial Primary Pulmonary Hypertension (blood, epidemiology)
• Female
• Humans
• Hypertension, Pulmonary (blood, epidemiology)
• Male
• Middle Aged
• Prognosis
• Pulmonary Embolism (blood, epidemiology)
• Retrospective Studies
• Risk Assessment
• Survival Rate