A Nomogram to Predict the 28-day Mortality of Critically Ill Patients With Acute Kidney Injury and Treated With Continuous Renal Replacement Therapy

Link to article at PubMed

Am J Med Sci. 2020 Nov 26:S0002-9629(20)30516-4. doi: 10.1016/j.amjms.2020.11.028. Online ahead of print.


BACKGROUND: Acute kidney injury (AKI) is a severe and common complication in critically ill patients and is associated with increased morbidity and mortality. At present, there is not a tool to predict the prognosis of critically ill patients with AKI and treated with continuous renal replacement therapy (CRRT).

METHODS: A retrospective cohort study was to construct a prediction model for the 28-day mortality of patients with AKI and treated with CRRT. From January 2009 to September 2016, A total of 846 cases were included in our study.

RESULTS: A total of five variables selected by multi-factor Cox regression analysis were used to constructed three predictive models and adopted bootstrapping for internal validation. Finally, we get five sets of models (three sets of construction models and two sets of internal verification models) with similar predictive value. The stepwise model, which including four variables (CCI score, Alb, Phosphate (24h) and SOFA score), was the simplest model, so we chose it as our final predictive model and constructed a nomogram based on it. The area under the ROC curve (AUC) of the stepwise model and the stepwise bootstrap model (BS stepwise) were respectively 0.78(0.75,0.82) and 0.78 (0.75,0.82). The AUC of the stepwise model and the BS stepwise in patients with sepsis were 0.77 (0.73,0.81) and 0.77 (0.73,0.81). The AUC of the stepwise model and the BS stepwise in patients without sepsis were 0.83 (0.78,0.89) and 0.83 (0.78,0.89).

CONCLUSIONS: We developed a four-marker-based prognostic tool that could effectively predict each individual's 28-day mortality for patients with AKI and treated with CRRT.

PMID:33288206 | DOI:10.1016/j.amjms.2020.11.028

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