[Development and validation of a nomogram for predicting 3-month mortality risk in patients with sepsis-associated acute kidney injury].

Abstract

Objective: To develop and evaluate a nomogram prediction model for the 3-month mortality risk of patients with sepsis-associated acute kidney injury (S-AKI).

Methods: Based on the American Medical Information Mart for Intensive Care- IV (MIMIC- IV), clinical data of S-AKI patients from 2008 to 2021 were collected. Initially, 58 relevant predictive factors were included, with all-cause mortality within 3 months as the outcome event. The data were divided into training and testing sets at a 7 : 3 ratio. In the training set, univariate Logistic regression analysis was used for preliminary variable screening. Multicollinearity analysis, Lasso regression, and random forest algorithm were employed for variable selection, combined with the clinical application value of variables, to establish a multivariable Logistic regression model, visualized using a nomogram. In the testing set, the predictive value of the model was evaluated through internal validation. The receiver operator characteristic curve (ROC curve) was drawn, and the area under the curve (AUC) was calculated to evaluate the discrimination of nomogram model and Oxford acute severity of illness score (OASIS), sequential organ failure assessment (SOFA), and systemic inflammatory response syndrome score (SIRS). The calibration curve was used to evaluate the calibration, and decision curve analysis (DCA) was performed to assess the net benefit at different probability thresholds.

Results: Based on the survival status at 3 months after diagnosis, patients were divided into 7 768 (68.54%) survivors and 3 566 (31.46%) death. In the training set, after multiple screenings, 7 variables were finally included in the nomogram model: Logistic organ dysfunction system (LODS), Charlson comorbidity index, urine output, international normalized ratio (INR), respiratory support mode, blood urea nitrogen, and age. Internal validation in the testing set showed that the AUC of nomogram model was 0.81 [95% confidence interval (95%CI) was 0.80-0.82], higher than the OASIS score's 0.70 (95%CI was 0.69-0.71) and significantly higher than the SOFA score's 0.57 (95%CI was 0.56-0.58) and SIRS score's 0.56 (95%CI was 0.55-0.57), indicating good discrimination. The calibration curve demonstrated that the nomogram model's calibration was better than the OASIS, SOFA, and SIRS scores. The DCA curve suggested that the nomogram model's clinical net benefit was better than the OASIS, SOFA, and SIRS scores at different probability thresholds.

Conclusions: A nomogram prediction model for the 3-month mortality risk of S-AKI patients, based on clinical big data from MIMIC- IV and including seven variables, demonstrates good discriminative ability and calibration, providing an effective new tool for assessing the prognosis of S-AKI patients.