Prediction and prognosis of adverse maternal and foetal/neonatal outcomes in pulmonary hypertension: an observational study and nomogram construction

Figures

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  Fig. 1. Nomogram development and validation (Maternal mortality or heart failure). A The nomogram incorporates five variables, with points allocated according to the scale for each variable. A total score was awarded from the sum of the individual scores, and used to calculate the predicted probability of maternal mortality or heart failure. B (a, b) Calibration curves for the nomogram in the Development (a) and Validation (b) cohorts. The calibration plot illustrates the accuracy of the original prediction (“Apparent”: light dotted line) and bootstrap models (“Bias-corrected”: solid line) in predicting the probability of maternal mortality or heart failure. C (a, b) Decision curve analysis for the nomogram in the Development (a) and Validation (b) cohorts. The y-axis indicates the net benefit, which is the sum of the benefits (true positives) minus harm (false positives). The x-axis indicates the threshold probability. The red line represents the nomogram net benefit. The yellow and blue lines represent the hypotheses that all or no patients experienced maternal mortality or heart failure, respectively. D (a, b) Violin plot analysis compared the distribution of risk prediction…

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  Fig. 2. Nomogram development and validation (Overall survival). A: The nomogram incorporates five variables, with points allocated according to the scale for each variable. A total score was awarded from the sum of the individual scores, and used to calculate the predicted overall survival (OS) of pregnant patients with PH at 1, 2, and 3 years. B (a, b): ROC curve of the 1, 2, and 3-year survival predictions in the Follow-up (a) and (follow-up) Validation sets (b). The red, blue, and orange lines represent the AUC of the ROC curves for 1, 2, and 3 years, respectively. C (a, b): Decision curve analysis for the prognostic nomogram in the Follow-up (a) and (follow-up) Validation sets (b). The y-axis indicates the net benefit, which is the sum of the benefits (true positives) minus harm (false positives). The x-axis indicates the threshold probability. The red, blue, and orange lines represent the 1, 2, and 3-year survival benefits, respectively. AUC area under the curve, NT-proBNP N-terminal pro-brain natriuretic peptide, NYHA New York Heart Association, PH pulmonary hypertension, RF respiratory failure, ROC receiver operating characteristic

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  Fig. 3. Calibration curves of the 1, 2, and 3-year overall survival and risk stratification. A (a–c) Calibration curves of the 1, 2, and 3-year OS for pregnant women with PH in the Follow-up set. B (a–c) Calibration curves of the 1, 2, and 3-year OS for pregnant women with PH in the Validation set. The light blue line indicates the ideal reference line where predicted probabilities would match the observed survival rates. The red dots are calculated by bootstrapping (resample: 1000) and represent the nomogram’s performance. The closer the solid red line is to the light blue line, the more accurately the model predicts survival. C Kaplan–Meier OS curves for the low-risk and high-risk pregnant women with PH stratified by the prognostic nomogram in the Follow-up set. According to the median cut-off value, samples were divided into high-risk and low-risk groups. D Kaplan–Meier OS curves for the low-risk and high-risk pregnant women with PH stratified by the prognostic nomogram in the Validation set. OS overall survival, PH pulmonary hypertension

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  Fig. 4. Nomogram development and validation (Adverse foetal/neonatal events). A The nomogram incorporates seven variables, with points allocated according to the scale for each variable. A total score was awarded from the sum of the individual scores, and used to calculate the predicted probability of adverse foetal/neonatal events. B (a, b) Calibration curves for the nomogram in the Delivery (a) and Validation (b) groups. The calibration plot illustrates the accuracy of the original prediction (“Apparent”: light dotted line) and bootstrap models (“Bias-corrected”: solid line) in predicting the probability of adverse foetal/neonatal events. C (a, b) Decision curve analysis for the nomogram in the Delivery (a) and Validation (b) groups. The y-axis indicates the net benefit, which is the sum of the benefits (true positives) minus harm (false positives). The x-axis indicates the threshold probability. The red line represents the net nomogram benefit. The yellow and blue lines represent the hypotheses that all and no patients had adverse foetal/neonatal events, respectively. D (a, b) Violin plot analysis compared the distribution of risk prediction probabilities for those with adverse…