1. Development and Validation of a Nomogram for Predicting the Long-Term Survival in Patients With Chronic Thromboembolic Pulmonary Hypertension
- Author
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Wu Song, Song Hu, Ting-Ting Guo, Sheng Liu, Lu Hua, Yan Wu, Xin Gao, Fu-Hua Peng, and Jiang-Shan Tan
- Subjects
Endothelin Receptor Antagonists ,Male ,Multivariate analysis ,Body Mass Index ,Atrial Pressure ,Natriuretic Peptide, Brain ,Natriuretic peptide ,Anemia ,Middle Aged ,Prognosis ,Survival Rate ,Cohort ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Adult ,medicine.medical_specialty ,medicine.drug_class ,Hypertension, Pulmonary ,Enzyme Activators ,Endarterectomy ,Pulmonary Artery ,Clinical Decision Rules ,Internal medicine ,medicine ,Humans ,In patient ,Pulmonary Wedge Pressure ,Mortality ,Antihypertensive Agents ,Aged ,Proportional Hazards Models ,Proportional hazards model ,business.industry ,Reproducibility of Results ,Phosphodiesterase 5 Inhibitors ,Nomogram ,medicine.disease ,Epoprostenol ,Peptide Fragments ,Nomograms ,Pyrimidines ,Chronic Disease ,Multivariate Analysis ,Pyrazoles ,Pulmonary Embolism ,business ,Body mass index ,Angioplasty, Balloon - Abstract
There remains a lack of prognosis models for patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study aims to develop a nomogram predicting 3-, 5-, and 7-year survival in patients with CTEPH and verify the prognostic model. Patients with CTEPH diagnosed in Fuwai Hospital were enrolled consecutively between May 2013 and May 2019. Among them, 70% were randomly split into a training set and the other 30% as a validation set for external validation. Cox proportional hazards model was used to identify the potential survival-related factors which were candidate variables for the establishment of nomogram and the final model was internally validated by the bootstrap method. A total of 350 patients were included in the final analysis and the median follow-up period of the whole cohort was 51.2 months. Multivariate analysis of Cox proportional hazards regression showed body mass index, mean right atrial pressure, N-terminal pro-brain natriuretic peptide (per 500 ng/ml increase in concentration), presence of anemia, and main treatment choice were the independent risk factors of mortality. The nomogram demonstrated good discrimination with the corrected C-index of 0.82 in the training set, and the C-index of 0.80 (95% CI: 0.70 to 0.91) in the external validation set. The calibration plots also showed a good agreement between predicted and actual survival in both training and validation sets. In conclusion, we developed an easy-to-use nomogram with good apparent performance using 5 readily available variables, which may help physicians to identify CTEPH patients at high risk for poor prognosis and implement medical interventions.
- Published
- 2022