摘要
Abstract
Objective To establish a personalized Nomogram model for predicting the risk of pulmonary hypertension(PH)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Propensity score matc-hing and retrospective study performed,clinical data were collected from 317 patients with acute exacerbation of chronic obstructive pulmonary disease and 287 patients with concomitant pulmonary hypertension(treated in our hospital from June 2021 to June 2023).According to the 1∶1 nearest neighbor matching method,they were divided into a combined group of 231 cases and an un-combined group of 231 cases.Using the same method,patients were selected for external validation(treated in our hospital from June 2023 to June 2024)and divided into a combined group of 99 cases and an uncombined group of 99 cases.Clinical data of pa-tients were collected.Logistic regression was applied to analyze influencing factors.R3.6.3 software and RMS package were ap-plied to construct a Nomogram model for predicting AECOPD combined PH.The differentiation,consistency,and clinical utility of AECOPD combined with PH prediction models were evaluated using ROC,calibration,and clinical decision(DCA)curves.Re-sults Multivariate Logistic analysis revealed that age,N-terminal pro brain natriuretic peptide(NT-proBNP),C-reactive protein(CRP),D-dimer(D-D),red blood cell distribution width(RDW),mean platelet volume(MPV),and forced expiratory volume in the first second(FEV1)were all factors affecting pH(P<0.05).The Nomogram model showed that CRP,D-D,RDW,MPV,FEV1,age≥70 years,and NT-proBNP≥300 pg/ml respectively increase the corresponding weights(FEV1 decreases).H-L fitting test and ROC curve evaluation were used to evaluate model,and results showed good consistency and differentiation.The external validation group also showed good alignment curve consistency with an AUC of 0.873(95%CI 0.822～0.914)and good model differentiation.Clinical decision making(DCA)curve showed that clinical value of the model was higher when probability ranged from10%to 96%.Conclusion Age,NT-proBNP,CRP,D-D,RDW,MPV,and FEV1 are all influencing factors of PH in AECO-PD patients.The Nomogram model established in this study based on the above 7 factors has high clinical practicality.关键词
慢性阻塞性肺疾病急性发作/肺动脉高压/Nomogram模型Key words
acute exacerbation of chronic obstructive pulmonary disease/pulmonary hypertension/Nomogram model分类
医药卫生
