Hu Song, Tan Jiang-Shan, Liu Sheng, Guo Ting-Ting, Song Wu, Peng Fu-Hua, Wu Yan, Gao Xin, Hua Lu
Thrombosis Center, Key Laboratory of Pulmonary Vascular Medicine, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiac Surgery, Adult Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Am J Cardiol. 2022 Jan 15;163:109-116. doi: 10.1016/j.amjcard.2021.09.045. Epub 2021 Nov 10.
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.
慢性血栓栓塞性肺动脉高压（CTEPH）患者仍然缺乏预后模型。本研究旨在开发一种列线图，预测CTEPH患者3年、5年和7年生存率，并验证该预后模型。2013年5月至2019年5月期间，连续纳入在阜外医院诊断为CTEPH的患者。其中，70%被随机分为训练集，另外30%作为外部验证的验证集。采用Cox比例风险模型识别潜在的生存相关因素，这些因素是建立列线图的候选变量，最终模型通过自举法进行内部验证。最终分析共纳入350例患者，整个队列的中位随访时间为51.2个月。Cox比例风险回归多因素分析显示，体重指数、平均右心房压力、N末端脑钠肽前体（浓度每增加500 ng/ml）、贫血的存在以及主要治疗选择是死亡的独立危险因素。该列线图在训练集中校正C指数为0.82，具有良好的区分度，在外部验证集中C指数为0.80（95%CI：0.70至0.91）。校准图还显示，训练集和验证集中预测生存与实际生存之间具有良好的一致性。总之，我们使用5个易于获得的变量开发了一种易于使用且具有良好表观性能的列线图，这可能有助于医生识别预后不良的高危CTEPH患者并实施医疗干预。
