The development and validation of a prediction model for post-AKI outcomes of pediatric inpatients.

Abstract

Background: Acute kidney injury (AKI) is common in hospitalized children. A post-AKI outcomes prediction model is important for the early detection of important clinical outcomes associated with AKI so that early management of pediatric AKI patients can be initiated.

Methods: Three retrospective cohorts were set up based on two pediatric hospitals in China, in which 8205 children suffered AKI during hospitalization. Two clinical outcomes were evaluated, i.e. hospital mortality and dialysis within 28 days after AKI occurrence. A Genetic Algorithm was used for feature selection, and a Random Forest model was built to predict clinical outcomes. Subsequently, a temporal validation set and an external validation set were used to evaluate the performance of the prediction model. Finally, the stratification ability of the prediction model for the risk of mortality was compared with a commonly used mortality risk score, the pediatric critical illness score (PCIS).

Results: The prediction model performed well for the prediction of hospital mortality with an area under the receiver operating curve (AUROC) of 0.854 [95% confidence interval (CI) 0.816-0.888], and the AUROC was >0.850 for both temporal and external validation. For the prediction of dialysis, the AUROC was 0.889 (95% CI 0.871-0.906). In addition, the AUROC of the prediction model for hospital mortality was superior to that of PCIS (P < .0001 in both temporal and external validation).

Conclusions: The new proposed post-AKI outcomes prediction model shows potential applicability in clinical settings.