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 life-threatening complication in cirrhotic patients and is closely associated with the prognosis of these patients. The mortality of AKI in patients with cirrhosis was as high as 80%. Therefore, the identification of patients with AKI at high risk of death is necessary to improve their prognosis.
The majority of studies have focused on investigating the risk factors for the development of AKI or establishing a risk score model for predicting the development of AKI. However, studies focused on identifying the potential risk factors for cirrhotic patients with AKI are scarce.
This study aimed to identify risk factors of mortality and establish a nomogram for predicting overall survival in cirrhotic patients with AKI.
We included 250 eligible cirrhotic patients with AKI in this study. These patients were randomly divided into a training cohort and a validation cohort at a ratio of 2:1. Potential risk factors for death were investigated by performing a Cox regression analysis of the training cohort. A prognostic nomogram was developed and evaluated by calculating the area under the curve of the receiver operating characteristic curve, 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 considered potential risk factors for death in cirrhotic patients with AKI. The nomogram based on these risk factors has a good performance in predicting the short-term prognosis of cirrhotic patients with AKI. The cutoff value of 98 for the nomogram score was used to stratify patients; patients were divided into low- and high-risk groups, and high-risk patients had a higher mortality rate.
The nomogram was a practical tool to predict the short-term prognosis of patients with cirrhosis who were diagnosed with AKI, and assist clinicians in making clinical decisions.
The reliability and practicability of nomogram must be validated by conducting prospective, large-scale and multicenter studies. Application programs or software that can be embedded in electronic medical systems will be developed to guide clinicians in the timely evaluation and treatment of these patients.