Development and validation of novel prognostic hepatic-cardiac index and hemodynamic prediction models in pre-capillary pulmonary hypertension patients
- 1Department of Cardiology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University
- 2Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yuexiu District
- 3Department of Cardiology, Punan Hospital
Abstract
Pulmonary arterial hypertension (PAH) is a life-threatening disorder marked by progressive elevation of pulmonary vascular resistance and ultimate right heart failure. Its diagnosis and risk stratification largely depend on invasive right heart catheterization (RHC). This study aimed to integrate routine laboratory and echocardiographic data to develop a novel multi-organ prognostic indicator and construct non-invasive hemodynamic estimation prediction models. This was a multi-center retrospective study enrolling a total of 44 routine laboratory and echocardiographic indices of pre-capillary pulmonary hypertension. Key prognostic variables were screened using Least absolute shrinkage and selection operator-Cox (LASSO-Cox) regression and random survival forest (RSF) analysis. The novel composite index was constructed based on correlation analysis with hemodynamic parameters. Prognostic performance was evaluated using Cox regression, Time-Dependent Receiver Operating Characteristic (time-dependent ROC) curve analysis, stratified analysis, and decision curve analysis (DCA). Linear prediction models for invasive hemodynamic parameters were established using variable selection and internal validation. A total of 179 patients with pre-capillary pulmonary hypertension were included. Using LASSO-Cox and random survival forest, 13 core prognostic variables were identified, including total bilirubin (TB) and B-type natriuretic peptide (BNP). The novel hepatic-cardiac index--TBI (log [total bilirubin × BNP]) was constructed and validated as an independent prognostic factor (HR=1.64, 95%CI: 1.287–2.09, P=0.0001). Predictive efficacy at 36 months was significantly higher for TBI (area under the curve, AUC = 0.777) than for BNP (AUC = 0.723, P = 0.021 with false discovery rate [FDR] adjustment). Stratified analysis confirmed that TBI remained prognostic in patients with BNP levels between 200 and 800 pg/mL (χ2=7.075, P = 0.008). Additionally, non-invasive linear prediction models for mean pulmonary arterial pressure(mPAP), pulmonary vascular resistance (PVR), and PVR×CO (cardiac output) were established with moderate accuracy (R2=0.575, 0.507, 0.523, respectively) Integration of laboratory and echocardiographic parameters enables improved non-invasive evaluation in pulmonary hypertension. The novel hepatic-cardiac index (TBI, log[TB×BNP]) serves as a robust and independent prognostic biomarker. Routine non-invasive indices can reliably estimate key hemodynamic parameters in clinical practice.
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BibTeX
@article{tong2026development,
title = {{Development and validation of novel prognostic hepatic-cardiac index and hemodynamic prediction models in pre-capillary pulmonary hypertension patients}},
author = {Jun Tong and An Wang and Chuanxue Wan and Mengqi Chen and Qi Zhuang and Binqian Ruan and Jinyao Jiang and Menghui Yang and Jieyan Shen},
journal = {Scientific Reports},
year = {2026},
month = jul,
doi = {10.1038/s41598-026-62666-1},
url = {https://doi.org/10.1038/s41598-026-62666-1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Development and validation of novel prognostic hepatic-cardiac index and hemodynamic prediction models in pre-capillary pulmonary hypertension patients
AU - Jun Tong
AU - An Wang
AU - Chuanxue Wan
AU - Mengqi Chen
AU - Qi Zhuang
AU - Binqian Ruan
AU - Jinyao Jiang
AU - Menghui Yang
AU - Jieyan Shen
PY - 2026
DA - 2026/07/01
JO - Scientific Reports
DO - 10.1038/s41598-026-62666-1
UR - https://doi.org/10.1038/s41598-026-62666-1
AB - Pulmonary arterial hypertension (PAH) is a life-threatening disorder marked by progressive elevation of pulmonary vascular resistance and ultimate right heart failure. Its diagnosis and risk stratification largely depend on invasive right heart catheterization (RHC). This study aimed to integrate routine laboratory and echocardiographic data to develop a novel multi-organ prognostic indicator and construct non-invasive hemodynamic estimation prediction models. This was a multi-center retrospective study enrolling a total of 44 routine laboratory and echocardiographic indices of pre-capillary pulmonary hypertension. Key prognostic variables were screened using Least absolute shrinkage and selection operator-Cox (LASSO-Cox) regression and random survival forest (RSF) analysis. The novel composite index was constructed based on correlation analysis with hemodynamic parameters. Prognostic performance was evaluated using Cox regression, Time-Dependent Receiver Operating Characteristic (time-dependent ROC) curve analysis, stratified analysis, and decision curve analysis (DCA). Linear prediction models for invasive hemodynamic parameters were established using variable selection and internal validation. A total of 179 patients with pre-capillary pulmonary hypertension were included. Using LASSO-Cox and random survival forest, 13 core prognostic variables were identified, including total bilirubin (TB) and B-type natriuretic peptide (BNP). The novel hepatic-cardiac index--TBI (log [total bilirubin × BNP]) was constructed and validated as an independent prognostic factor (HR=1.64, 95%CI: 1.287–2.09, P=0.0001). Predictive efficacy at 36 months was significantly higher for TBI (area under the curve, AUC = 0.777) than for BNP (AUC = 0.723, P = 0.021 with false discovery rate [FDR] adjustment). Stratified analysis confirmed that TBI remained prognostic in patients with BNP levels between 200 and 800 pg/mL (χ2=7.075, P = 0.008). Additionally, non-invasive linear prediction models for mean pulmonary arterial pressure(mPAP), pulmonary vascular resistance (PVR), and PVR×CO (cardiac output) were established with moderate accuracy (R2=0.575, 0.507, 0.523, respectively) Integration of laboratory and echocardiographic parameters enables improved non-invasive evaluation in pulmonary hypertension. The novel hepatic-cardiac index (TBI, log[TB×BNP]) serves as a robust and independent prognostic biomarker. Routine non-invasive indices can reliably estimate key hemodynamic parameters in clinical practice.
SN - 2045-2322
ER -