A routine-data-based nomogram incorporating neutrophil-to-lymphocyte ratio, B-type natriuretic peptide, D-dimer, and asthma history demonstrated good discrimination (AUC 0.82) for estimating pulmonary hypertension risk in elderly patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease.
Key Findings
Results
Four variables were independently associated with pulmonary hypertension in elderly AECOPD patients and incorporated into the nomogram.
The four independent predictors identified were: neutrophil-to-lymphocyte ratio (NLR), B-type natriuretic peptide (BNP), D-dimer, and asthma history.
Predictors were selected through a sequential process involving univariate analysis, clinical relevance assessment, redundancy assessment, and multivariable logistic regression.
Variables represent routine clinical data including complete blood count indices, coagulation markers, cardiac stress markers, and comorbidity history.
These variables were available from routine hospitalization workup, making the model applicable in primary and resource-limited settings.
Results
The nomogram demonstrated good discrimination for identifying pulmonary hypertension in the study cohort.
The area under the receiver operating characteristic curve (AUC) was 0.82.
The study included 230 elderly patients hospitalized with AECOPD between May 2023 and May 2025.
Patients were classified into non-pulmonary hypertension and pulmonary hypertension groups according to transthoracic echocardiographic findings.
The model underwent internal evaluation; external validation was not performed.
Results
Decision curve analysis indicated potential net clinical benefit across a wide range of threshold probabilities.
Decision curve analysis showed potential net benefit across threshold probabilities of approximately 1% to 70%.
This range of net benefit suggests the nomogram could be clinically useful across varying pre-test probability scenarios.
Decision curve analysis was used to evaluate clinical utility beyond discrimination alone.
Results
Calibration findings required cautious interpretation due to residual calibration deviation.
The paper explicitly notes that 'calibration findings required cautious interpretation due to residual calibration deviation.'
Residual calibration deviation indicates that the model's predicted probabilities may not perfectly align with observed outcomes.
The authors identified model recalibration as a requirement before broader clinical implementation.
This limitation was acknowledged alongside the need for external validation.
Methods
The study population consisted of 230 elderly patients hospitalized with acute exacerbation of COPD at a single center over a two-year period.
The retrospective cohort study enrolled patients between May 2023 and May 2025.
Patients were classified into non-pulmonary hypertension and pulmonary hypertension groups.
Group comparisons included demographic characteristics, comorbidities, complete blood count indices, coagulation markers, inflammatory markers, and cardiac stress markers.
Transthoracic echocardiography was used as the reference standard for pulmonary hypertension classification.
Background
The nomogram was developed to address the difficulty of early pulmonary hypertension risk estimation in primary and resource-limited hospital settings.
Pulmonary hypertension is described as 'a clinically important complication in elderly patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease.'
Early risk estimation was identified as 'difficult in primary and resource-limited hospital settings.'
The model relies exclusively on routine clinical data to enable applicability where advanced diagnostics may be unavailable.
External validation and model recalibration were stated as requirements before broader clinical implementation.
What This Means
This research suggests that a simple scoring tool (called a nomogram) built from routine hospital test results can help identify elderly patients with worsening chronic obstructive pulmonary disease (COPD) who may also have dangerously high blood pressure in their lungs — a condition called pulmonary hypertension. The tool uses four pieces of information that are already collected during a standard hospital admission: a ratio of two types of white blood cells (neutrophil-to-lymphocyte ratio), a heart stress hormone (BNP), a blood clotting marker (D-dimer), and whether the patient has a history of asthma. Tested in 230 patients, the tool correctly distinguished those with and without pulmonary hypertension about 82% of the time, which is considered a good level of accuracy.
Pulmonary hypertension is hard to detect early because it typically requires specialized heart ultrasound equipment and expertise that may not be readily available in smaller or lower-resource hospitals. This research suggests that combining widely available blood test results into a single scoring tool could allow doctors in these settings to identify high-risk patients earlier and potentially refer them for further testing or closer monitoring. The analysis also showed that the tool could provide real-world clinical benefit across a broad range of patient risk levels.
However, the study has important limitations: it was conducted at a single center, included only 230 patients, and the tool was only tested on the same patients used to build it — meaning its accuracy in new patient populations is unknown. The authors also noted some imperfection in how well the tool's predicted risk scores matched actual patient outcomes (calibration deviation). Before this tool could be used in routine clinical care, it would need to be tested in different hospitals and patient populations, and possibly adjusted to improve its accuracy.
Wu M, Zhang L, Wang X, Xu S, Xie L. (2026). Routine-Data Nomogram for Estimating Pulmonary Hypertension Risk in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.. Journal of visualized experiments : JoVE. https://doi.org/10.3791/72233