Development and Validation of a Nomogram for Predicting Acute Kidney Injury in Septic Patients

Abstract

Li Zhao,1 Tuo Zhang,2 Xunliang Li,3 Li Chen,1 Shenglin Zhou,1 Zhaoli Meng,1 Wei Fang,1 Jianle Xu,4 Jicheng Zhang,1 Man Chen1,2 1Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China; 2Department of Critical Care Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, People’s Republic of China; 3Department of Intensive Care Unit, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China; 4Department of Statistics and Medical Records Management, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of ChinaCorrespondence: Jicheng Zhang; Man Chen, Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, People’s Republic of China, Email [email protected]; [email protected]: Sepsis-associated acute kidney injury (S-AKI) is associated with increased morbidity and mortality. We aimed to develop a nomogram for predicting the risk of S-AKI patients.Patients and Methods: We collected data from septic patients admitted to the Provincial Hospital Affiliated with Shandong First Medical University from January 2019 to September 2022. Septic patients were divided into two groups based on the occurrence of AKI. A nomogram was developed by multiple logistic regression analyses. The performance of the nomogram was evaluated using C-statistics, calibration curves, and decision curve analysis (DCA). The validation cohort contained 70 patients between December 2022, and March 2023 in the same hospital.Results: 198 septic patients were enrolled in the training cohort. Multivariate logistic regression analysis showed that neutrophil gelatinase-associated lipocalin (NGAL), platelet-to-lymphocyte ratio (PLR), and vasopressor use were independent risk factors for S-AKI. A nomogram was developed based on these factors. C-statistics for the training and validation cohorts were respectively 0.873 (95% CI 0.825– 0.921) and 0.826 (95% CI 0.727– 0.924), indicating high prediction accuracy. The calibration curves showed good concordance. DCA revealed that the nomogram was of great clinical value.Conclusion: The nomogram presents early and effective prediction for the S-AKI patients, and provides optimal intervention to improve patient outcomes.Keywords: sepsis, acute kidney injury, neutrophil gelatinase-associated lipocalin, platelet-to-lymphocyte ratio, vasopressor use, nomogram

Keywords

• sepsis
• acute kidney injury
• neutrophil gelatinase-associated lipocalin
• platelet-to-lymphocyte ratio
• vasopressor use
• nomogram