Development and Validation of a Prediction Model for Pulmonary Arterial Hypertension in Diabetic Patients: A Retrospective Study of 57,375 Patients.
7 affiliations
- 1Key Laboratory of BioResource and Eco-Environment of Ministry of Education, College of Life Science, Sichuan University; Sichuan Provincial People's Hospital University of Electronic Science and Technology of China Chengdu China.
- 2School of Computer Science University of Electronic Science and Technology of China Chengdu China.
- 3Institute of Organ Transplantation, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital University of Electronic Science and Technology of China Chengdu China.
- 4Department of Pulmonary Arterial Hypertension, Sichuan Provincial People's Hospital University of Electronic Science and Technology of China Chengdu China.
- 5Key Laboratory of BioResource and Eco-Environment of Ministry of Education, College of Life Science Sichuan University Chengdu China.
- 6Department of Cardiovascular Ultrasound, Sichuan Provincial People's Hospital University of Electronic Science and Technology of China Chengdu China.
- 7Department of Dermatology, Sichuan Provincial People's Hospital University of Electronic Science and Technology of China Chengdu China.
Abstract
Pulmonary arterial hypertension (PAH) is an important cardiopulmonary complication in patients with type 2 diabetes mellitus (T2DM), yet practical models integrating routinely available clinical, laboratory, and echocardiographic information remain limited. We conducted a single-center retrospective electronic medical record cohort study with a prespecified temporal split. Patients admitted from January 1, 2018 to December 31, 2021 formed the training cohort, and those admitted from January 1, 2022 to July 31, 2025 formed the temporal validation cohort. Among 47,042 pre-2022 records screened, 10,458 eligible patients were included in the training cohort, including 423 patients with PAH (4.0%); among 60,069 later records screened, 14,060 patients were included in the validation cohort, including 600 patients with PAH (4.3%). Nine prespecified clinical domains were initially evaluated. Because tricuspid regurgitation velocity/gradient contributed to the echocardiographic PAH classification, a sensitivity analysis excluded the PAH-related pressure-gradient domain from the exploratory combined model to reduce incorporation bias. In the training-cohort sensitivity analysis, cardiac cavity and vascular dilatation was the strongest remaining individual discriminator (area under the curve [AUC], 0.819), followed by coagulation dysfunction (AUC, 0.697) and cardiac dysfunction (AUC, 0.627); the pressure-gradient-excluded combined model achieved an AUC of 0.823. When applied without refitting to the temporal validation cohort, this sensitivity model achieved an AUC of 0.780. The eight-variable echocardiography-informed nomogram had a C-index of 0.666 (95% confidence interval [CI], 0.631-0.699), with a Hosmer-Lemeshow p value of 0.453. Because the nomogram includes echocardiographic predictors, including tricuspid regurgitation velocity and pulmonary valve velocity, it is intended for risk stratification after echocardiography rather than pre-echocardiographic screening or prediction of incident PAH. Diabetes-specific variables such as HbA1c, diabetes duration, treatment exposure, insulin resistance indices, and microvascular complications were not consistently available in the historical records and were not modeled. Prospective multicenter studies with systematic collection of diabetes-specific variables are needed.
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BibTeX
@article{geng2026development,
title = {{Development and Validation of a Prediction Model for Pulmonary Arterial Hypertension in Diabetic Patients: A Retrospective Study of 57,375 Patients.}},
author = {Zhen Geng and Junjie Yao and Hailian Wang and Yunshan Cao and Jinku Bao and Jia Chen and Jianing Yang and Yi Wang},
journal = {Pulmonary circulation},
year = {2026},
month = oct,
doi = {10.1002/pul2.70431},
url = {https://europepmc.org/article/MED/42920960},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Development and Validation of a Prediction Model for Pulmonary Arterial Hypertension in Diabetic Patients: A Retrospective Study of 57,375 Patients.
AU - Zhen Geng
AU - Junjie Yao
AU - Hailian Wang
AU - Yunshan Cao
AU - Jinku Bao
AU - Jia Chen
AU - Jianing Yang
AU - Yi Wang
PY - 2026
DA - 2026/10/23
JO - Pulmonary circulation
DO - 10.1002/pul2.70431
UR - https://europepmc.org/article/MED/42920960
AB - Pulmonary arterial hypertension (PAH) is an important cardiopulmonary complication in patients with type 2 diabetes mellitus (T2DM), yet practical models integrating routinely available clinical, laboratory, and echocardiographic information remain limited. We conducted a single-center retrospective electronic medical record cohort study with a prespecified temporal split. Patients admitted from January 1, 2018 to December 31, 2021 formed the training cohort, and those admitted from January 1, 2022 to July 31, 2025 formed the temporal validation cohort. Among 47,042 pre-2022 records screened, 10,458 eligible patients were included in the training cohort, including 423 patients with PAH (4.0%); among 60,069 later records screened, 14,060 patients were included in the validation cohort, including 600 patients with PAH (4.3%). Nine prespecified clinical domains were initially evaluated. Because tricuspid regurgitation velocity/gradient contributed to the echocardiographic PAH classification, a sensitivity analysis excluded the PAH-related pressure-gradient domain from the exploratory combined model to reduce incorporation bias. In the training-cohort sensitivity analysis, cardiac cavity and vascular dilatation was the strongest remaining individual discriminator (area under the curve [AUC], 0.819), followed by coagulation dysfunction (AUC, 0.697) and cardiac dysfunction (AUC, 0.627); the pressure-gradient-excluded combined model achieved an AUC of 0.823. When applied without refitting to the temporal validation cohort, this sensitivity model achieved an AUC of 0.780. The eight-variable echocardiography-informed nomogram had a C-index of 0.666 (95% confidence interval [CI], 0.631-0.699), with a Hosmer-Lemeshow p value of 0.453. Because the nomogram includes echocardiographic predictors, including tricuspid regurgitation velocity and pulmonary valve velocity, it is intended for risk stratification after echocardiography rather than pre-echocardiographic screening or prediction of incident PAH. Diabetes-specific variables such as HbA1c, diabetes duration, treatment exposure, insulin resistance indices, and microvascular complications were not consistently available in the historical records and were not modeled. Prospective multicenter studies with systematic collection of diabetes-specific variables are needed.
SN - 2045-8932
SN - 2045-8940
ER -