Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Nephrology, Affiliated Hospital of Jining Medical University, Jining, China.
BMC Nephrol. 2024 May 21;25(1):175. doi: 10.1186/s12882-024-03609-8.
The purpose of this study was to develop a nomogram for predicting in-hospital mortality in cirrhotic patients with acute kidney injury (AKI) in order to identify patients with a high risk of in-hospital death early.
This study collected data on cirrhotic patients with AKI from 2008 to 2019 using the Medical Information Mart for Intensive Care IV. Multivariate logistic regression was used to identify confounding factors related to in-hospital mortality, which were then integrated into the nomogram. The concordance index (C-Index) was used to evaluate the accuracy of the model predictions. The area under the curve (AUC) and decision curve analysis (DCA) was used to assess the predictive performance and clinical utility of the nomogram.
The final study population included 886 cirrhotic patients with AKI, and 264 (29.8%) died in the hospital. After multivariate logistic regression, age, gender, cerebrovascular disease, heart rate, respiration rate, temperature, oxygen saturation, hemoglobin, blood urea nitrogen, serum creatinine, international normalized ratio, bilirubin, urine volume, and sequential organ failure assessment score were predictive factors of in-hospital mortality. In addition, the nomogram showed good accuracy in estimating the in-hospital mortality of patients. The calibration plots showed the best agreement with the actual presence of in-hospital mortality in patients. In addition, the AUC and DCA curves showed that the nomogram has good prediction accuracy and clinical value.
We have created a prognostic nomogram for predicting in-hospital death in cirrhotic patients with AKI, which may facilitate timely intervention to improve prognosis in these patients.
本研究旨在为肝硬化合并急性肾损伤（AKI）患者构建预测院内病死率的列线图，以便早期识别出院内死亡风险较高的患者。
本研究使用医疗信息集市-加强护理 IV（Medical Information Mart for Intensive Care IV）收集了 2008 年至 2019 年肝硬化合并 AKI 患者的数据。采用多变量逻辑回归分析确定与院内病死率相关的混杂因素，并将其纳入列线图。采用一致性指数（C-Index）评估模型预测的准确性。采用曲线下面积（AUC）和决策曲线分析（DCA）评估列线图的预测性能和临床实用性。
最终研究人群包括 886 例肝硬化合并 AKI 患者，其中 264 例（29.8%）患者院内死亡。多变量逻辑回归分析后，年龄、性别、脑血管疾病、心率、呼吸频率、体温、血氧饱和度、血红蛋白、血尿素氮、血清肌酐、国际标准化比值、胆红素、尿量和序贯器官衰竭评估评分是院内病死率的预测因素。此外，该列线图在估计患者院内病死率方面具有较好的准确性。校准图显示与患者实际院内病死率的吻合度最佳。此外，AUC 和 DCA 曲线表明该列线图具有较好的预测准确性和临床价值。
我们构建了一个预测肝硬化合并 AKI 患者院内死亡的预后列线图，有助于及时干预以改善这些患者的预后。
