Key result
Nine-variable risk nomogram predicts PAH in stage 3-5 CKD with an AUC of ~0.80.
Why the study?
Pulmonary arterial hypertension significantly worsens prognosis in chronic kidney disease, but predictive models to guide early intervention in stage 3-5 CKD were needed.
Can a nomogram based on clinical and echocardiographic variables predict the development of pulmonary arterial hypertension in patients with stage 3-5 chronic kidney disease?
Observational (n=1,197)
Yes
Can a nomogram based on clinical and echocardiographic variables predict the development of pulmonary arterial hypertension in patients with stage 3-5 chronic kidney disease?
A novel nomogram incorporating nine clinical and echocardiographic variables demonstrated good discriminative ability for predicting the development of pulmonary arterial hypertension in patients with stage 3-5 chronic kidney disease.
Answers are grounded in this paper and cite their sources.
May aid PAH risk stratification in advanced CKD; leaves open prospective validation before clinical use.
OBJECTIVES: The occurrence of pulmonary arterial hypertension (PAH) can greatly affect the prognosis of patients with chronic kidney disease (CKD). We aimed to construct a nomogram to predict the probability of PAH development in patients with stage 3-5 CKD to guide early intervention and to improve prognosis. METHODS: From August 2018 to December 2021, we collected the data of 1258 patients with stage 3-5 CKD hospitalized at the Affiliated Hospital of Xuzhou Medical University as a training set and 389 patients hospitalized at Zhongda Hospital as a validation set. These patients were divided into PAH and N-PAH groups with pulmonary arterial systolic pressure ≥ 35 mmHg as the cutoff. The results of univariate and multivariate logistic regression analyses were used to establish the nomogram. Then, areas under the receiver operating characteristic curve (AUC-ROCs), a calibration plot, and decision curve analysis (DCA) were used to validate the nomogram. RESULTS: The nomogram included nine variables: age, diabetes mellitus, hemoglobin, platelet count, serum creatinine, left ventricular end-diastolic diameter, left atrial diameter, main pulmonary artery diameter and left ventricular ejection fraction. The AUC-ROCs of the training set and validation set were 0.801 (95% confidence interval (CI) 0.771-0.830) and 0.760 (95% CI 0.699-0.818), respectively, which showed good discriminative ability of the nomogram. The calibration diagram showed good agreement between the predicted and observed results. DCA also demonstrated that the nomogram could be clinically useful. CONCLUSION: The evaluation of the nomogram model for predicting PAH in patients with CKD based on risk factors showed its ideal efficacy. Thus, the nomogram can be used to screen for patients at high risk for PAH and has guiding value for the subsequent formulation of prevention strategies and clinical treatment.
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Hu et al. (2022) conducted an observational in Stage 3-5 chronic kidney disease (CKD) (n=1,197). Risk nomogram model was evaluated on Area under the receiver operating characteristic curve (AUC-ROC) for predicting pulmonary arterial hypertension in the training set (95% CI 0.771-0.830). A risk nomogram incorporating nine clinical and echocardiographic variables predicted pulmonary arterial hypertension in patients with stage 3-5 chronic kidney disease with an AUC of 0.801.
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