Development and validation of an early acute kidney injury risk prediction model for patients with sepsis in emergency departments

• Published in: Renal failure 2024-12, Vol.46 (2), p.2419523
• Main Authors: Lin, Chen, Lin, Siming, Zheng, Meng, Cai, Kexin, Wang, Jing, Luo, Yuqing, Lin, Zhihong, Feng, Shaodan
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury; Acute Kidney Injury - blood; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Aged; Aged, 80 and over; emergency department; Emergency medical care; Emergency Service, Hospital; Female; Humans; Kidneys; Logistic Models; Male; Middle Aged; nomogram; Nomograms; prediction; Prediction models; Procalcitonin; Regression analysis; Retrospective Studies; Risk assessment; Risk Assessment - methods; Risk Factors; ROC Curve; Sepsis; Sepsis - complications; Sepsis - diagnosis
• ISSN: 0886-022X; 1525-6049; 1525-6049
• DOI: 10.1080/0886022X.2024.2419523

In this study, we aimed to develop and validate a nomogram to predicting the risk of sepsis-associated acute kidney injury (SA-AKI) in patients admitted to emergency departments (EDs). We randomly divided a retrospective dataset of 391 patients with sepsis into a 294-person training cohort and a 97-person validation cohort, and developed three predictive models using multivariate logistic regression analysis and clinical insight. No difference was observed between the three models using the DeLong test and Model 3 was selected as the risk prediction model based on the principle of least inclusion indicators. The use of vasopressor drugs, patient age, platelet count, procalcitonin, and D-dimer levels were included. The training and validation cohorts had a consistency index of 0.832 and 0.866, respectively, indicating high accuracy and stability in predicting SA-AKI risk. The area under the receiver operating characteristic curve was 0.832, showing excellent discrimination. The calibration curves for the training and validation cohorts showed excellent calibration. The decision curve and clinical impact curve analyses showed that the net clinical benefit of using the nomogram was greatest over a probability threshold of 0.05-0.90. In addition, the model showed moderate validity in predicting the 30-day survival and the incidence of major adverse renal events within 30 days. The nomogram developed for SA-AKI risk assessment in patients in EDs showed good discriminability and clinical utility. It can provide a theoretical basis for emergency physicians to prevent SA-AKI.