Journal Article

A novel risk-predicted nomogram for sepsis associated-acute kidney injury among critically ill patients

Su, Tingting, Huang, Lina, Liao, Tianbao, Yang, Shanglin, Feng, Lu-Huai

2021

Overview

Background Acute kidney injury (AKI) is a prevalent and severe complication of sepsis contributing to high morbidity and mortality among critically ill patients. In this retrospective study, we develop a novel risk-predicted nomogram of sepsis associated-AKI (SA-AKI). Methods A total of 2,871 patients from the Medical Information Mart for Intensive Care III (MIMIC-III) critical care database were randomly assigned to primary (2,012 patients) and validation (859 patients) cohorts. A risk-predicted nomogram for SA-AKI was developed through multivariate logistic regression analysis in the primary cohort while the nomogram was evaluated in the validation cohort. Nomogram discrimination and calibration were assessed using C-index and calibration curves in the primary and external validation cohorts. The clinical utility of the final nomogram was evaluated using decision curve analysis. Results Risk predictors included in the prediction nomogram included length of stay in intensive care unit (LOS in ICU), baseline serum creatinine (SCr), glucose, anemia, and vasoactive drugs. Nomogram revealed moderate discrimination and calibration in estimating the risk of SA-AKI, with an unadjusted C-index of 0.752, 95 %Cl (0.730–0.774), and a bootstrap-corrected C index of 0.749. Application of the nomogram in the validation cohort provided moderate discrimination (C-index, 0.757 [95 % CI, 0.724–0.790]) and good calibration. Besides, the decision curve analysis (DCA) confirmed the clinical usefulness of the nomogram. Conclusions This study developed and validated an AKI risk prediction nomogram applied to critically ill patients with sepsis, which may help identify reasonable risk judgments and treatment strategies to a certain extent. Nevertheless, further verification using external data is essential to enhance its applicability in clinical practice.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute kidney injury / Acute Kidney Injury - diagnosis / Acute Kidney Injury - etiology / Acute renal failure / Aged / Aged, 80 and over / Anemia / Anemia - complications / Blood Glucose - metabolism / Body mass index / Calibration / Chronic obstructive pulmonary disease / Complications and side effects / Creatinine / Creatinine - blood / Critical Care / Critical Illness / Drug discrimination / Drugs / Female / Heart failure / Humans / Intensive care unit / Internal Medicine / Kidney diseases / Kidneys / Laboratories / Length of Stay / Liver diseases / Male / Medicine / Medicine & Public Health / Middle Aged / Morbidity / Mortality / Nephrology / Nomogram / Nomograms / Nomography (Mathematics) / Patients / Prediction / Regression Analysis / Retrospective Studies / Risk Assessment - methods / Risk Factors / Sepsis / Sepsis - complications / Software / Statistical analysis / Variables / Vasoactive agents