Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4133
Peer-review started: February 7, 2022
First decision: April 10, 2022
Revised: April 29, 2022
Accepted: July 22, 2022
Article in press: July 22, 2022
Published online: August 14, 2022
Acute kidney injury (AKI) is a common and severe complication in patients with cirrhosis, and is associated with poor prognosis. Therefore, identifying cirrhotic patients with AKI who are at high risk of mortality is very important and may be helpful for providing timely medical interventions to improve the prognosis of these patients. However, studies focused on investigating the risk factors for the mortality of cirrhotic patients with AKI were scarce.
To identify risk factors for mortality and establish a nomogram for predicting the prognosis of these patients.
Two hundred fifty consecutive patients with cirrhosis and AKI were recruited and randomly divided into training cohort (n = 173) and validation cohort (n = 77). In the training cohort, potential risk factors for death were identified by performing a Cox regression analysis, and a nomogram was established. The predictive performance of the nomogram was internally and externally validated by calculating the area under the receiver operating characteristic curve (AUROC), constructing a calibration curve and performing decision curve analysis.
The serum sodium level, international normalized ratio, peak serum creatinine level > 1.5 mg/dL, the presence of hepatic encephalopathy and diabetes were potential risk factors for mortality of cirrhotic patients with AKI in the training dataset. A prognostic nomogram incorporating these variables was established for predicting the overall survival of these patients. Compared with Child-Turcotte-Pugh, the model for end-stage liver disease (MELD) and the MELD-Na scores, the nomogram in predicting 90- and 180-d mortality exhibited better discriminatory power with AUROCs of 0.792 and 0.801 for the training dataset and 0.817 and 0.862 for the validation dataset, respectively. With a nomogram score of 98, patients were divided into low- and high-risk groups, and high-risk patients had a higher mortality rate.
A prognostic nomogram displayed good performance for predicting the overall survival of cirrhotic patients with AKI, and will assist clinicians in evaluating the prognosis of these patients.
Core Tip: We investigated the potential risk factors for death in cirrhotic patients with acute kidney injury (AKI). A nomogram incorporating these risk factors was developed and evaluated by calculating the area under the receiver operating characteristic curve, constructing a calibration curve and performing decision curve analysis. Compared with Child-Turcotte-Pugh, the model for end-stage liver disease (MELD) and MELD-Na score, the nomogram has a better discriminative ability in predicting the overall survival of cirrhotic patients with AKI. Moreover, the nomogram was used to select patients with a high risk of death and assist clinicians in making clinical decisions.