Qi Xin1, Tonghui Xie1, Rui Chen1, Hai Wang1, Xing Zhang1, Shufeng Wang2, Chang Liu3,4, Jingyao Zhang5,6. 1. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. 2. Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, China. dawn@mail.xjtu.edu.cn. 3. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. liuchangdoctor@163.com. 4. Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. liuchangdoctor@163.com. 5. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. you12ouy@163.com. 6. Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. you12ouy@163.com.
Abstract
BACKGROUND: Sepsis-induced acute kidney injury (S-AKI) is a significant complication and is associated with an increased risk of mortality, especially in elderly patients with sepsis. However, there are no reliable and robust predictive models to identify high-risk patients likely to develop S-AKI. We aimed to develop a nomogram to predict S-AKI in elderly sepsis patients and help physicians make personalized management within 24 h of admission. METHODS: A total of 849 elderly sepsis patients from the First Affiliated Hospital of Xi'an Jiaotong University were identified and randomly divided into a training set (75%, n = 637) and a validation set (25%, n = 212). Univariate and multivariate logistic regression analyses were performed to identify the independent predictors of S-AKI. The corresponding nomogram was constructed based on those predictors. The calibration curve, receiver operating characteristics (ROC)curve, and decision curve analysis were performed to evaluate the nomogram. The secondary outcome was 30-day mortality and major adverse kidney events within 30 days (MAKE30). MAKE30 were a composite of death, new renal replacement therapy (RRT), or persistent renal dysfunction (PRD). RESULTS: The independent predictors for nomogram construction were mean arterial pressure (MAP), serum procalcitonin (PCT), and platelet (PLT), prothrombin time activity (PTA), albumin globulin ratio (AGR), and creatinine (Cr). The predictive model had satisfactory discrimination with an area under the curve (AUC) of 0.852-0.858 in the training and validation cohorts, respectively. The nomogram showed good calibration and clinical application according to the calibration curve and decision curve analysis. Furthermore, the prediction model had perfect predictive power for predicting 30-day mortality (AUC = 0.813) and MAKE30 (AUC = 0.823) in elderly sepsis patients. CONCLUSION: The proposed nomogram can quickly and effectively predict S-AKI risk in elderly sepsis patients within 24 h after admission, providing information for clinicians to make personalized interventions.
BACKGROUND: Sepsis-induced acute kidney injury (S-AKI) is a significant complication and is associated with an increased risk of mortality, especially in elderly patients with sepsis. However, there are no reliable and robust predictive models to identify high-risk patients likely to develop S-AKI. We aimed to develop a nomogram to predict S-AKI in elderly sepsis patients and help physicians make personalized management within 24 h of admission. METHODS: A total of 849 elderly sepsis patients from the First Affiliated Hospital of Xi'an Jiaotong University were identified and randomly divided into a training set (75%, n = 637) and a validation set (25%, n = 212). Univariate and multivariate logistic regression analyses were performed to identify the independent predictors of S-AKI. The corresponding nomogram was constructed based on those predictors. The calibration curve, receiver operating characteristics (ROC)curve, and decision curve analysis were performed to evaluate the nomogram. The secondary outcome was 30-day mortality and major adverse kidney events within 30 days (MAKE30). MAKE30 were a composite of death, new renal replacement therapy (RRT), or persistent renal dysfunction (PRD). RESULTS: The independent predictors for nomogram construction were mean arterial pressure (MAP), serum procalcitonin (PCT), and platelet (PLT), prothrombin time activity (PTA), albumin globulin ratio (AGR), and creatinine (Cr). The predictive model had satisfactory discrimination with an area under the curve (AUC) of 0.852-0.858 in the training and validation cohorts, respectively. The nomogram showed good calibration and clinical application according to the calibration curve and decision curve analysis. Furthermore, the prediction model had perfect predictive power for predicting 30-day mortality (AUC = 0.813) and MAKE30 (AUC = 0.823) in elderly sepsis patients. CONCLUSION: The proposed nomogram can quickly and effectively predict S-AKI risk in elderly sepsis patients within 24 h after admission, providing information for clinicians to make personalized interventions.
Authors: Mervyn Singer; Clifford S Deutschman; Christopher Warren Seymour; Manu Shankar-Hari; Djillali Annane; Michael Bauer; Rinaldo Bellomo; Gordon R Bernard; Jean-Daniel Chiche; Craig M Coopersmith; Richard S Hotchkiss; Mitchell M Levy; John C Marshall; Greg S Martin; Steven M Opal; Gordon D Rubenfeld; Tom van der Poll; Jean-Louis Vincent; Derek C Angus Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: M S Nielsson; C F Christiansen; M B Johansen; B S Rasmussen; E Tønnesen; M Nørgaard Journal: Acta Anaesthesiol Scand Date: 2013-10-13 Impact factor: 2.105