Pulmonary Vascular Disease: PAH |

Scoring System for Screening of Pulmonary Hypertension in Scleroderma: The Dibosa Study FREE TO VIEW

Abhishek Gadre, MD; Christian Ghattas, MD; Omar Minai, MD; Kristin Highland, MD
Author and Funding Information

Cleveland Clinic, Cleveland, OH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1149A. doi:10.1016/j.chest.2016.08.1259
Text Size: A A A
Published online


SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 01:30 PM - 03:00 PM

PURPOSE: Current predictive models for Pulmonary Hypertension (PH) in Scleroderma are extremely complex to use. Objective of this study was to develop and validate a simple scoring system for screening of PH in Scleroderma based on six minute walk.

METHODS: Scleroderma patients seen at the Cleveland Clinic between 2003 and 2013 were screened (n=311). Patients with six minute walk test data and right heart catheterization (RHC) or echocardiographic data were identified (n=229). Patients with mean pulmonary artery pressure (mPAP) <25 mmHg or right ventricular systolic pressure (RVSP) <35 mmHg were classified as No-PH. Patients with RVSP≥35 mmHg were classified by RHC. mPAP≥25mm Hg was classified as With-PH. All 229 patients were randomized into Training Cohort (n=115) or Validation Cohort (n=114). Training Cohort was evaluated to create a scoring system using multivariate analysis and logistic regression. Scoring system was validated in Validation Cohort.

RESULTS: Three variables which were significantly different on multivariate analysis were six minute walk distance, Borg dyspnea scale and saturation of oxygen at six minutes. Scores were assigned based on beta regression coefficients. Total score ranges from 0 to 7. Using C-statistics the area under receiver operator curve (ROC)=87.50% in Training cohort and P <0.001; based on a score ≥1, sensitivity of predicting PH=100%, specificity was 37.0%; for score=5, sensitivity=86.0%, specificity=75.4%; score=7, sensitivity=68.0%, specificity=91.8%. In Validation Cohort, ROC = 88.87% and P<0.001; for score ≥1, sensitivity=100%, specificity=44.9%. For score of 5, sensitivity=87.5% and specificity=77.3%; for score=7, sensitivity=58.3%, specificity=92.4%.

CONCLUSIONS: DIBOSA score is a simple and highly sensitive scoring system to screen for PH in scleroderma.

CLINICAL IMPLICATIONS: A low risk score rules out PH and indicates no further work up. A medium risk score is highly sensitive for PH and indicates further work up. A high risk score is highly specific for predicting PH and indicates a RHC.

DISCLOSURE: The following authors have nothing to disclose: Abhishek Gadre, Christian Ghattas, Omar Minai, Kristin Highland

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543