REVEAL 2.0 Risk Score Calculator

REVEAL 2.0 Risk Score: Explanation and Clinical Context The REVEAL 2.0 Risk Score (Registry to Evaluate Early and Long-term PAH Disease Management 2.0) is a validated and widely used prognostic model developed to estimate 1-year mortality in patients with pulmonary arterial hypertension (PAH). It is based on the large U.S. REVEAL registry and integrates demographic, clinical, laboratory, echocardiographic, and hemodynamic variables.

Each variable contributes positively or negatively to the total score according to its association with mortality. Higher scores indicate a greater risk of death within one year. Parameters include age, sex, etiology (such as systemic sclerosis), vital signs, WHO functional class, 6-minute walk distance, BNP/NT-proBNP, hemodynamic findings (RAP, PVR, cardiac index), and recent hospitalization or clinical worsening.

REVEAL 2.0 stratifies patients into three risk categories: low risk (=6), intermediate (7–8), and high (=9). This stratification helps guide therapeutic decisions, including escalation to parenteral prostacyclin therapy or referral for lung transplantation. REVEAL 2.0 has been validated for both incident and prevalent PAH cases and demonstrates superior predictive performance compared to earlier models.

The simplified version, REVEAL Lite 2, uses six non-invasive parameters—functional class, heart rate, systolic blood pressure, 6MWD, BNP/NT-proBNP, and recent hospitalization—maintaining high predictive accuracy for outpatient follow-up. Clinical Significance: This score enables clinicians to monitor disease progression, optimize treatment intensity, and identify high-risk patients early. Serial assessment (every 3–6 months) is recommended to evaluate treatment response and prognostic evolution.