Figure 2.

Nomogram for predicting 6-year probability of survival. Instructions for using the nomogram are as follows. Estimate the patient's GFR from his or her most recent serum creatinine level. Locate the value of the patient's age according to baseline medication and GFR in A, draw a line straight upward to the Points axis to determine the number of points contributed by age. Repeat this process for the other variables in the model. Sum the points achieved for each predictor in A. Repeat this process in B. Sum the points obtained in both parts of the nomogram, and find this total on the Total Points axis at the bottom of B. Draw a straight line down from the total points axis to determine the probability of 6-year survival. An important point to note about nomograms is the U-shaped relationship. In this nomogram, for instance, the LDL cholesterol predictor variable has a U-shaped relationship with the probability of survival. This is presented in the nomogram by having the direct relationship on one side of the scale and the indirect relationship on the other side of the scale. LDL cholesterol levels from 150 to 0 are shown under the scale and have a direct relationship with survival, whereas LDL cholesterol values from 150 to 450 are shown on the top of the scale and have an indirect relationship with survival. In other words, a patient with an LDL cholesterol of exactly 150 has the highest probability of survival, and as the LDL cholesterol goes up or down from 150, the risk of mortality increases. An example of use of the nomogram is the following. A 50-year-old man with type 2 diabetes presents today for his first visit at Cleveland Clinic. The physician caring for the patient (Pt) wants to know the risk of mortality for this specific patient over the next 6 years if he or she prescribes a BIG. Here are the characteristics for this patient along with the calculation using the survival nomogram: age 50 years, taking BIG, GFR 60 ml/min (18 points); A1C 10.0% (3 points); BMI 35 kg/m² (0 points); systolic blood pressure 140 mmHg (0 points); diastolic blood pressure 80 mmHg (3 points); HDL cholesterol 35 mg/dl (6 points); LDL cholesterol 100 mg/dl (1 point); triglycerides 200 mg/dl (1 point); male sex (3 points); Caucasian (7 points); no heart disease (0 points); no heart failure (0 points); no smoking (0 points); no insulin (0 points); no ACE/ARBs (5 points); not newly diabetic (10 points); aspirin, yes (0 points); no clopidogrel (0 points); and no lipid-lowering drugs (0 points). Total points = 57. Probability of 6-year survival ∼0.94. Nomogram calculator available online from http://www.clinicriskcalculators.org.