The six-minute walk test (6MWT) has been used in patients with sickle cell disease (SCD), in conjunction with tricuspid regurgitant velocity (TRV) and plasma N-terminal pro-brain natriuretic peptide (NT-pro BNP), to assess risk of having pulmonary hypertension. Exercise-induced vital sign changes (VSCs) are predictors of clinical outcomes in other diseases. In this study, we assess the predictors and prognostic value of 6MWT VSC in adult SCD patients. Data from a multinational study of SCD patients (Treatment of Pulmonary Hypertension with Sildenafil: walk-PHaSST) were used to calculate the 6MWT VSC. Predictors of VSC were identified by a multivariable analysis, and a survival analysis was conducted by the Cox proportional hazard method. An increase in heart rate was observed in 90% of the 630 SCD adults, 77% of patients had an increase in systolic blood pressure (SBP), and 50% of patients had a decrease in oxygen saturation. TRV (odds ratio [OR] = 1.82, p = .020), absolute reticulocyte count (OR = 1.03, p < .001), and hemoglobin (OR = 0.99, p = .035) predicted oxygen desaturation ≥ 3% during the 6MWT. In the adjusted analysis, SBP increase during the 6MWT was associated with improved survival (hazards ratio = 0.3, 95% confidence interval: 0.1–0.8). Increases in heart rate and blood pressure, as well as oxygen desaturation, are common in adults with SCD during the 6MWT. VSC is associated with markers of anemia and TRV and can be used for risk stratification. Any increase in SBP during the 6MWT was associated with improved survival and may be indicative of a patient's ability to increase stroke volume.

中文翻译：

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运动引起的镰状细胞病成人生命体征变化

六分钟步行试验 (6MWT) 已与三尖瓣反流速度 (TRV) 和血浆 N 末端脑利钠肽原 (NT-pro BNP) 一起用于镰状细胞病 (SCD) 患者，以评估患肺动脉高压的风险。运动引起的生命体征变化 (VSC) 是其他疾病临床结果的预测因子。在这项研究中，我们评估了 6MWT VSC 在成人 SCD 患者中的预测因子和预后价值。来自 SCD 患者的多国研究（使用西地那非治疗肺动脉高压：walk-PHaSST）的数据用于计算 6MWT VSC。通过多变量分析确定了 VSC 的预测因子，并通过 Cox 比例风险法进行了生存分析。在 630 名 SCD 成人中，90% 的人观察到心率增加，77% 的患者收缩压 (SBP) 升高，50% 的患者氧饱和度降低。TRV（比值比 [OR] = 1.82，p  = .020）、绝对网织红细胞计数（OR = 1.03，p  < .001）和血红蛋白（OR = 0.99，p  = .035）预测 6MWT 期间氧饱和度降低 ≥ 3%。在调整后的分析中，6MWT 期间 SBP 增加与生存率提高相关（风险比 = 0.3，95% 置信区间：0.1–0.8）。在 6MWT 期间，心率和血压升高以及氧饱和度降低在患有 SCD 的成人中很常见。VSC 与贫血和 TRV 的标志物相关，可用于风险分层。在 6MWT 期间 SBP 的任何增加都与改善的生存相关，并且可能表明患者增加每搏输出量的能力。