Wei Chaolian, Cao Honghua, Huang Lina, Feng Lu-Huai
Department of Gastric and Abdominal Tumor Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.
Department of Gastrointestinal Surgery, Guigang People's Hospital, Guigang, China.
Front Med (Lausanne). 2024 Oct 3;11:1474311. doi: 10.3389/fmed.2024.1474311. eCollection 2024.
Acute kidney injury (AKI) is a common and serious complication in patients with acute non-variceal upper gastrointestinal bleeding (NVUGIB). Early prediction and intervention are crucial for improving patient outcomes.
Data for patients presenting with acute NVUGIB in this retrospective study were sourced from the MIMC-IV database. Patients were randomly allocated into training and validation cohorts for further analysis. Independent predictors for AKI were identified using least absolute shrinkage and selection operator regression and multivariable logistic regression analyses in the training cohort. Based on the logistic regression results, a nomogram was developed to predict early AKI onset in acute NVUGIB patients, and implemented as a web-based calculator for clinical application. The nomogram's performance was evaluated through discrimination, using the C-index, calibration curves, and decision curve analysis (DCA) to assess its clinical value.
The study involved 1082 acute NVUGIB patients, with 406 developing AKI. A multivariable logistic regression identified five key AKI predictors: CKD, use of human albumin, chronic liver disease, glucose, and blood urea nitrogen. The nomogram was constructed based on independent predictors. The nomogram exhibited robust accuracy, evidenced by a C-index of 0.73 in the training cohort and 0.72 in the validation cohort. Calibration curves demonstrated satisfactory concordance between predicted and observed AKI occurrences. DCA revealed that the nomogram offered considerable clinical benefit within a threshold probability range of 7% to 54%.
Our nomogram is a valuable tool for predicting AKI risk in patients with acute NVUGIB, offering potential for early intervention and improved clinical outcomes.
急性肾损伤（AKI）是急性非静脉曲张性上消化道出血（NVUGIB）患者常见且严重的并发症。早期预测和干预对于改善患者预后至关重要。
本回顾性研究中急性NVUGIB患者的数据来源于MIMC-IV数据库。患者被随机分配到训练队列和验证队列进行进一步分析。在训练队列中，使用最小绝对收缩和选择算子回归及多变量逻辑回归分析确定AKI的独立预测因素。基于逻辑回归结果，开发了一种列线图来预测急性NVUGIB患者早期AKI的发生，并作为基于网络的计算器用于临床应用。通过使用C指数、校准曲线和决策曲线分析（DCA）评估列线图的辨别能力，以评估其临床价值。
该研究纳入了1082例急性NVUGIB患者，其中406例发生了AKI。多变量逻辑回归确定了五个关键的AKI预测因素：慢性肾脏病、人血白蛋白的使用、慢性肝病、血糖和血尿素氮。基于独立预测因素构建了列线图。列线图显示出强大的准确性，训练队列中的C指数为0.73，验证队列中的C指数为0.72。校准曲线表明预测的和观察到的AKI发生情况之间具有令人满意的一致性。DCA显示，在7%至54%的阈值概率范围内，列线图具有相当大的临床益处。
我们的列线图是预测急性NVUGIB患者AKI风险的有价值工具，为早期干预和改善临床结局提供了可能性。
