Derivation and internal validation of prediction models for pulmonary hypertension risk assessment in a cohort inhabiting Tibet, China

• Published in: eLife Vol. 13
• Main Authors: Tang, Junhui, Yang, Rui, Li, Hui, Wei, Xiaodong, Yang, Zhen, Cai, Wenbin, Jiang, Yao, Zhuo, Ga, Meng, Li, Xu, Yali
• Format: Journal Article
• Language: English
• Published: England eLife Sciences Publications Ltd 11.11.2024; eLife Sciences Publications, Ltd
• Subjects: Adult; Age; Aged; Altitude; Cardiac arrhythmia; Cohort Studies; Computational and Systems Biology; electrocardiogram; Ethnicity; Female; Gender; Heart failure; high altitude; Human papillomavirus; Humans; Hypertension; Hypertension, Pulmonary - diagnosis; Hypoxia; Male; Middle Aged; Minority & ethnic groups; nomogram; Nomograms; prediction model; Prediction models; Pulmonary arteries; Pulmonary hypertension; Regression analysis; Risk assessment; Risk Assessment - methods; Risk Factors; Sinuses; Tachycardia; Tibet - epidemiology; transthoracic echocardiography; Variables; Tibet; China; computational biology; systems biology; electrocardiogram; high altitude; prediction model; pulmonary hypertension; transthoracic echocardiography; nomogram; human
• ISSN: 2050-084X; 2050-084X
• DOI: 10.7554/eLife.98169

Individuals residing in plateau regions are susceptible to pulmonary hypertension (PH) and there is an urgent need for a prediction nomogram to assess the risk of PH in this population. A total of 6603 subjects were randomly divided into a derivation set and a validation set at a ratio of 7:3. Optimal predictive features were identified through the least absolute shrinkage and selection operator regression technique, and nomograms were constructed using multivariate logistic regression. The performance of these nomograms was evaluated and validated using the area under the curve (AUC), calibration curves, the Hosmer–Lemeshow test, and decision curve analysis. Comparisons between nomograms were conducted using the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices. Nomogram I was established based on independent risk factors, including gender, Tibetan ethnicity, age, incomplete right bundle branch block (IRBBB), atrial fibrillation (AF), sinus tachycardia (ST), and T wave changes (TC). The AUCs for Nomogram I were 0.716 in the derivation set and 0.718 in the validation set. Nomogram II was established based on independent risk factors, including Tibetan ethnicity, age, right axis deviation, high voltage in the right ventricle, IRBBB, AF, pulmonary P waves, ST, and TC. The AUCs for Nomogram II were 0.844 in the derivation set and 0.801 in the validation set. Both nomograms demonstrated satisfactory clinical consistency. The IDI and NRI indices confirmed that Nomogram II outperformed Nomogram I . Therefore, the online dynamic Nomogram II was established to predict the risks of PH in the plateau population.