Development and validation of a dynamic online nomogram for predicting acute kidney injury in cirrhotic patients upon ICU admission.
Development and validation of a dynamic online nomogram for predicting acute kidney injury in cirrhotic patients upon ICU admission.
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DOI：
10.3389/fmed.2023.1055137
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发表时间：
2023
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
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急性肾损伤（AKI）是入住重症监护病房（ICU）的肝硬化患者中最常见且致命的并发症之一。我们旨在开发并验证一种简单且在临床上有用的动态列线图，用于预测肝硬化患者入住ICU时的AKI。
我们分析了重症监护病房IV（MIMIC - IV）数据库中2008年至2019年4375例入住ICU的肝硬化患者的入院数据。符合条件的肝硬化患者按照入院顺序以1∶1的比例非随机分为推导队列（n = 2188）和验证队列（n = 2187）。采用最小绝对收缩和选择算子回归模型来确定推导队列中AKI的独立预测因子。在推导队列中使用多变量逻辑回归分析构建动态在线列线图，然后在验证队列中进行验证。分别使用C指数、校准曲线和决策曲线分析来评估列线图的区分度、校准度和临床实用性。
4375例患者中AKI的发生率为71.3%。通过多变量逻辑回归分析，腹水、慢性肾脏病、休克、败血症、利尿剂、肝性脑病、细菌感染、血管活性药物、入院年龄、总胆红素和血尿素氮被确定为入住ICU时AKI的重要预测因子。在推导队列中，该模型显示出良好的区分度（C指数为0.786；95%置信区间为0.765 - 0.806）和良好的校准度。验证队列中的模型也显示出良好的区分度（C指数为0.774；95%置信区间为0.753 - 0.795）和良好的校准度。决策曲线分析表明动态在线列线图具有临床实用性。
我们的研究提出了一种动态在线列线图，它结合了临床预测因子，可方便地用于促进对肝硬化患者入住ICU时AKI的个体化预测。
Acute kidney injury (AKI) is one of the most common and deadly complications among cirrhotic patients at intensive care unit (ICU) admission. We aimed to develop and validate a simple and clinically useful dynamic nomogram for predicting AKI in cirrhotic patients upon ICU admission. We analyzed the admission data of 4,375 patients with liver cirrhosis in ICU from 2008 to 2019 in the intensive care unit IV (MIMIC-IV) database. The eligible cirrhotic patients were non-randomly divided into derivation (n = 2,188) and validation (n = 2,187) cohorts at a ratio of 1:1, according to the order of admission. The least absolute shrinkage and selection operator regression model was used to identify independent predictors of AKI in the derivation cohort. A dynamic online nomogram was built using multivariate logistic regression analysis in the derivation cohort and then validated in the validation cohort. The C-index, calibration curve, and decision curve analysis were used to assess the nomogram’s discrimination, calibration, and clinical usefulness, respectively. The incidence of AKI in 4,375 patients was 71.3%. Ascites, chronic kidney disease, shock, sepsis, diuretic drugs, hepatic encephalopathy, bacterial infections, vasoactive drugs, admission age, total bilirubin, and blood urea nitrogen were identified using the multivariate logistic regression analysis as significant predictors of AKI upon ICU admission. In the derivation cohort, the model showed good discrimination (C-index, 0.786; 95% CI, 0.765–0.806) and good calibration. The model in the validation cohort yielded good discrimination (C-index, 0.774; 95% CI, 0.753–0.795) and good calibration. Decision curve analysis demonstrated that the dynamic online nomogram was clinically useful. Our study presents a dynamic online nomogram that incorporates clinical predictors and can be conveniently used to facilitate the individualized prediction of AKI in cirrhotic patients upon ICU admission.
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DOI：
10.5005/jp-journals-10071-23721
发表时间：
2021-03
期刊：
Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
影响因子：
--
作者：
Rajakumar A;Appuswamy E;Kaliamoorthy I;Rela M
通讯作者：
Rela M
DOI：
10.1186/cc11454
发表时间：
2013-02-04
期刊：
Critical care (London, England)
影响因子：
--
作者：
Kellum JA;Lameire N;KDIGO AKI Guideline Work Group
通讯作者：
KDIGO AKI Guideline Work Group
DOI：
10.1016/j.cgh.2017.05.041
发表时间：
2018-03
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Mindikoglu AL;Pappas SC
通讯作者：
Pappas SC
影响因子：
8.1
作者：
Weil, Delphine;Levesque, Eric;Di Martino, Vincent
通讯作者：
Di Martino, Vincent
影响因子：
3.6
作者：
Vickers, Andrew J.;Elkin, Elena B.
通讯作者：
Elkin, Elena B.