Development and validation of a nomogram for predicting the occurrence of acute kidney injury in patients with pulmonary embolism.

BACKGROUND

Pulmonary embolism (PE) is associated with acute kidney injury (AKI). This study aimed to develop a nomogram to predict AKI in PE patients admitted to the intensive care unit.

METHODS

The data of patients with PE were obtained from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) and the eICU Collaborative Research Database, with AKI as the primary outcome. Patients from MIMIC-IV were divided into training (80%) and internal validation (20%) cohorts, and external validation was performed using the eICU. Independent risk factors for AKI were identified using univariable logistic regression and stepwise logistic regression. A nomogram was constructed based on the stepwise analysis. Its performance was evaluated using the receiver operating characteristic (ROC) area under the curve (AUC), calibration plots, decision curve analysis (DCA), and sensitivity analysis, and compared to the simplified acute physiology score (SAPS) II score.

RESULTS

Six independent risk factors for AKI were identified. The nomogram's AUC was 0.717 in the training cohort, 0.758 in the internal validation cohort, and 0.889 in the external validation cohort. The AUC of the nomogram was higher than the SAPS II score ( < 0.05). Calibration plots showed good consistency, and DCA confirmed its clinical applicability. Sensitivity analysis confirmed its stability and reliability.

CONCLUSION

The nomogram might help clinicians identify PE patients at risk for developing AKI and increase attention to these patients. It was externally validated in the eICU cohort and demonstrated good predictive ability.