Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2022; 28(30): 4133-4151
Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4133
Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury
Yi-Peng Wan, An-Jiang Wang, Wang Zhang, Hang Zhang, Gen-Hua Peng, Xuan Zhu
Yi-Peng Wan, An-Jiang Wang, Wang Zhang, Hang Zhang, Gen-Hua Peng, Xuan Zhu, Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang 331706, Jiangxi Province, China
Xuan Zhu, Biomolecular Research Laboratory, Jiangxi Clinical Research Center for Gastroenterology, Nanchang 331706, Jiangxi Province, China
Author contributions: Wan YP, Wang AJ and Zhang W equally contributed to this work; Wang AJ and Zhu X contributed to the concept; Wan YP, Wang AJ and Zhang W designed this study; Wan YP performed the manuscript writing; Zhang W performed data analysis; Zhang H and Peng GH contributed to samples collection and data collection and validation; Zhu X were clinical experts and performed the manuscript revision; all authors read and approved the final version of the manuscript.
Supported by the National Natural Science Foundation of China, No. 81960120 and No. 82160115.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Nanchang University (No. AF-SG-04-2.0).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of The First Affiliated Hospital of Nanchang University.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xuan Zhu, MD, Chief Doctor, Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang 331706, Jiangxi Province, China. waiyongtg@163.com
Received: February 7, 2022
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
Abstract
BACKGROUND

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.

AIM

To identify risk factors for mortality and establish a nomogram for predicting the prognosis of these patients.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Acute kidney injury, Cirrhosis, Nomogram, Prognosis

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.