Development and validation of a clinical prediction model for detecting coronary heart disease in middle-aged and elderly people: a diagnostic study
Abstract Objective To develop and validate a multivariate prediction model to estimate the risk of coronary heart disease (CHD) in middle-aged and elderly people and to provide a feasible method for early screening and diagnosis in middle-aged and elderly CHD patients. Methods This study was a singl...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-023-01233-0 |
| _version_ | 1827723829503328256 |
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| author | Shiyi Tao Lintong Yu Deshuang Yang Ruiqi Yao Lanxin Zhang Li Huang Mingjing Shao |
| author_facet | Shiyi Tao Lintong Yu Deshuang Yang Ruiqi Yao Lanxin Zhang Li Huang Mingjing Shao |
| author_sort | Shiyi Tao |
| collection | DOAJ |
| description | Abstract Objective To develop and validate a multivariate prediction model to estimate the risk of coronary heart disease (CHD) in middle-aged and elderly people and to provide a feasible method for early screening and diagnosis in middle-aged and elderly CHD patients. Methods This study was a single-center, retrospective, case–control study. Admission data of 932 consecutive patients with suspected CHD were retrospectively assessed from September 1, 2020 to December 31, 2021 in the Department of Integrative Cardiology at China-Japan Friendship Hospital. A total of 839 eligible patients were included in this study, and 588 patients were assigned to the derivation set and 251 as the validation set at a 7:3 ratio. Clinical characteristics of included patients were compared between derivation set and validation set by univariate analysis. The least absolute shrinkage and selection operator (Lasso) regression analysis method was performed to avoid collinearity and identify key potential predictors. Multivariate logistic regression analysis was used to construct a clinical prediction model with identified predictors for clinical practice. Bootstrap validation was used to test performance and eventually we obtained the actual model. And the Hosmer–Lemeshow test was carried out to evaluate the goodness-fit of the constructed model. The area under curve (AUC) of receiver operating characteristic (ROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were plotted and utilized with validation set to comprehensively evaluate the predictive accuracy and clinical value of the model. Results A total of eight indicators were identified as risk factors for the development of CHD in middle-aged and elderly people by univariate analysis. Of these candidate predictors, four key parameters were defined to be significantly related to CHD by Lasso regression analysis, including age (OR 1.034, 95% CI 1.002 ~ 1.067, P = 0.040), hemoglobin A1c (OR 1.380, 95% CI 1.078 ~ 1.768, P = 0.011), ankle-brachial index (OR 0.078, 95% CI 0.012 ~ 0.522, P = 0.009), and brachial artery flow-mediated vasodilatation (OR 0.848, 95% CI 0.726 ~ 0.990, P = 0.037). The Hosmer–Lemeshow test showed a good calibration performance of the clinical prediction model (derivation set, χ 2 = 7.865, P = 0.447; validation set, χ 2 = 11.132, P = 0.194). The ROCs of the nomogram in the derivation set and validation set were 0.722 and 0.783, respectively, suggesting excellent predictive power and suitable performance. The clinical prediction model presented a greater net benefit and clinical impact based on DCA and CIC analysis. Conclusion Overall, the development and validation of the multivariate model combined the laboratory and clinical parameters of patients with CHD, which could be beneficial to the individualized prediction of middle-aged and elderly people, and helped to facilitate clinical assessments and decisions during treatment and management of CHD. |
| first_indexed | 2024-03-10T22:06:17Z |
| format | Article |
| id | doaj.art-594cb6dcc50741b8a7e91d74d6bb9f17 |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-03-10T22:06:17Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-594cb6dcc50741b8a7e91d74d6bb9f172023-11-19T12:47:53ZengBMCEuropean Journal of Medical Research2047-783X2023-09-0128111310.1186/s40001-023-01233-0Development and validation of a clinical prediction model for detecting coronary heart disease in middle-aged and elderly people: a diagnostic studyShiyi Tao0Lintong Yu1Deshuang Yang2Ruiqi Yao3Lanxin Zhang4Li Huang5Mingjing Shao6Graduate School, Beijing University of Chinese MedicineGraduate School, Beijing University of Chinese MedicineDepartment of Integrative Cardiology, China-Japan Friendship HospitalDepartment of Internal Medicine, Shenzhen Nanshan Chinese Medicine HospitalDepartment of Oncology, Guang’anmenHospital, China Academy of Chinese Medical SciencesDepartment of Integrative Cardiology, China-Japan Friendship HospitalDepartment of Integrative Cardiology, China-Japan Friendship HospitalAbstract Objective To develop and validate a multivariate prediction model to estimate the risk of coronary heart disease (CHD) in middle-aged and elderly people and to provide a feasible method for early screening and diagnosis in middle-aged and elderly CHD patients. Methods This study was a single-center, retrospective, case–control study. Admission data of 932 consecutive patients with suspected CHD were retrospectively assessed from September 1, 2020 to December 31, 2021 in the Department of Integrative Cardiology at China-Japan Friendship Hospital. A total of 839 eligible patients were included in this study, and 588 patients were assigned to the derivation set and 251 as the validation set at a 7:3 ratio. Clinical characteristics of included patients were compared between derivation set and validation set by univariate analysis. The least absolute shrinkage and selection operator (Lasso) regression analysis method was performed to avoid collinearity and identify key potential predictors. Multivariate logistic regression analysis was used to construct a clinical prediction model with identified predictors for clinical practice. Bootstrap validation was used to test performance and eventually we obtained the actual model. And the Hosmer–Lemeshow test was carried out to evaluate the goodness-fit of the constructed model. The area under curve (AUC) of receiver operating characteristic (ROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were plotted and utilized with validation set to comprehensively evaluate the predictive accuracy and clinical value of the model. Results A total of eight indicators were identified as risk factors for the development of CHD in middle-aged and elderly people by univariate analysis. Of these candidate predictors, four key parameters were defined to be significantly related to CHD by Lasso regression analysis, including age (OR 1.034, 95% CI 1.002 ~ 1.067, P = 0.040), hemoglobin A1c (OR 1.380, 95% CI 1.078 ~ 1.768, P = 0.011), ankle-brachial index (OR 0.078, 95% CI 0.012 ~ 0.522, P = 0.009), and brachial artery flow-mediated vasodilatation (OR 0.848, 95% CI 0.726 ~ 0.990, P = 0.037). The Hosmer–Lemeshow test showed a good calibration performance of the clinical prediction model (derivation set, χ 2 = 7.865, P = 0.447; validation set, χ 2 = 11.132, P = 0.194). The ROCs of the nomogram in the derivation set and validation set were 0.722 and 0.783, respectively, suggesting excellent predictive power and suitable performance. The clinical prediction model presented a greater net benefit and clinical impact based on DCA and CIC analysis. Conclusion Overall, the development and validation of the multivariate model combined the laboratory and clinical parameters of patients with CHD, which could be beneficial to the individualized prediction of middle-aged and elderly people, and helped to facilitate clinical assessments and decisions during treatment and management of CHD.https://doi.org/10.1186/s40001-023-01233-0Coronary heart diseaseClinical prediction modelNomogramRisk factorDiagnostic study |
| spellingShingle | Shiyi Tao Lintong Yu Deshuang Yang Ruiqi Yao Lanxin Zhang Li Huang Mingjing Shao Development and validation of a clinical prediction model for detecting coronary heart disease in middle-aged and elderly people: a diagnostic study European Journal of Medical Research Coronary heart disease Clinical prediction model Nomogram Risk factor Diagnostic study |
| title | Development and validation of a clinical prediction model for detecting coronary heart disease in middle-aged and elderly people: a diagnostic study |
| title_full | Development and validation of a clinical prediction model for detecting coronary heart disease in middle-aged and elderly people: a diagnostic study |
| title_fullStr | Development and validation of a clinical prediction model for detecting coronary heart disease in middle-aged and elderly people: a diagnostic study |
| title_full_unstemmed | Development and validation of a clinical prediction model for detecting coronary heart disease in middle-aged and elderly people: a diagnostic study |
| title_short | Development and validation of a clinical prediction model for detecting coronary heart disease in middle-aged and elderly people: a diagnostic study |
| title_sort | development and validation of a clinical prediction model for detecting coronary heart disease in middle aged and elderly people a diagnostic study |
| topic | Coronary heart disease Clinical prediction model Nomogram Risk factor Diagnostic study |
| url | https://doi.org/10.1186/s40001-023-01233-0 |
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