Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury

OBJECTIVE: We aimed to analyze the risk factors affecting all-cause mortality in diabetic patients with acute kidney injury (AKI) and to develop and validate a nomogram for predicting the 90-day survival rate of patients. METHODS: Clinical data of diabetic patients with AKI who were diagnosed at The...

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Autores principales: Mo, Manqiu, Pan, Ling, Huang, Zichun, Liang, Yuzhen, Liao, Yunhua, Xia, Ning
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8727769/
https://www.ncbi.nlm.nih.gov/pubmed/35002952
http://dx.doi.org/10.3389/fendo.2021.737996
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author Mo, Manqiu
Pan, Ling
Huang, Zichun
Liang, Yuzhen
Liao, Yunhua
Xia, Ning
author_facet Mo, Manqiu
Pan, Ling
Huang, Zichun
Liang, Yuzhen
Liao, Yunhua
Xia, Ning
author_sort Mo, Manqiu
collection PubMed
description OBJECTIVE: We aimed to analyze the risk factors affecting all-cause mortality in diabetic patients with acute kidney injury (AKI) and to develop and validate a nomogram for predicting the 90-day survival rate of patients. METHODS: Clinical data of diabetic patients with AKI who were diagnosed at The First Affiliated Hospital of Guangxi Medical University from April 30, 2011, to April 30, 2021, were collected. A total of 1,042 patients were randomly divided into a development cohort and a validation cohort at a ratio of 7:3. The primary study endpoint was all-cause death within 90 days of AKI diagnosis. Clinical parameters and demographic characteristics were analyzed using Cox regression to develop a prediction model for survival in diabetic patients with AKI, and a nomogram was then constructed. The concordance index (C-index), receiver operating characteristic curve, and calibration plot were used to evaluate the prediction model. RESULTS: The development cohort enrolled 730 patients with a median follow-up time of 87 (40–98) days, and 86 patients (11.8%) died during follow-up. The 90-day survival rate was 88.2% (644/730), and the recovery rate for renal function in survivors was 32.9% (212/644). Multivariate analysis showed that advanced age (HR = 1.064, 95% CI = 1.043–1.085), lower pulse pressure (HR = 0.964, 95% CI = 0.951–0.977), stage 3 AKI (HR = 4.803, 95% CI = 1.678–13.750), lower 25-hydroxyvitamin D3 (HR = 0.944, 95% CI = 0.930–0.960), and multiple organ dysfunction syndrome (HR = 2.056, 95% CI = 1.287–3.286) were independent risk factors affecting the all-cause death of diabetic patients with AKI (all p < 0.01). The C-indices of the prediction cohort and the validation cohort were 0.880 (95% CI = 0.839–0.921) and 0.798 (95% CI = 0.720–0.876), respectively. The calibration plot of the model showed excellent consistency between the prediction probability and the actual probability. CONCLUSION: We developed a new prediction model that has been internally verified to have good discrimination, calibration, and clinical value for predicting the 90-day survival rate of diabetic patients with AKI.
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spelling pubmed-87277692022-01-06 Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury Mo, Manqiu Pan, Ling Huang, Zichun Liang, Yuzhen Liao, Yunhua Xia, Ning Front Endocrinol (Lausanne) Endocrinology OBJECTIVE: We aimed to analyze the risk factors affecting all-cause mortality in diabetic patients with acute kidney injury (AKI) and to develop and validate a nomogram for predicting the 90-day survival rate of patients. METHODS: Clinical data of diabetic patients with AKI who were diagnosed at The First Affiliated Hospital of Guangxi Medical University from April 30, 2011, to April 30, 2021, were collected. A total of 1,042 patients were randomly divided into a development cohort and a validation cohort at a ratio of 7:3. The primary study endpoint was all-cause death within 90 days of AKI diagnosis. Clinical parameters and demographic characteristics were analyzed using Cox regression to develop a prediction model for survival in diabetic patients with AKI, and a nomogram was then constructed. The concordance index (C-index), receiver operating characteristic curve, and calibration plot were used to evaluate the prediction model. RESULTS: The development cohort enrolled 730 patients with a median follow-up time of 87 (40–98) days, and 86 patients (11.8%) died during follow-up. The 90-day survival rate was 88.2% (644/730), and the recovery rate for renal function in survivors was 32.9% (212/644). Multivariate analysis showed that advanced age (HR = 1.064, 95% CI = 1.043–1.085), lower pulse pressure (HR = 0.964, 95% CI = 0.951–0.977), stage 3 AKI (HR = 4.803, 95% CI = 1.678–13.750), lower 25-hydroxyvitamin D3 (HR = 0.944, 95% CI = 0.930–0.960), and multiple organ dysfunction syndrome (HR = 2.056, 95% CI = 1.287–3.286) were independent risk factors affecting the all-cause death of diabetic patients with AKI (all p < 0.01). The C-indices of the prediction cohort and the validation cohort were 0.880 (95% CI = 0.839–0.921) and 0.798 (95% CI = 0.720–0.876), respectively. The calibration plot of the model showed excellent consistency between the prediction probability and the actual probability. CONCLUSION: We developed a new prediction model that has been internally verified to have good discrimination, calibration, and clinical value for predicting the 90-day survival rate of diabetic patients with AKI. Frontiers Media S.A. 2021-12-22 /pmc/articles/PMC8727769/ /pubmed/35002952 http://dx.doi.org/10.3389/fendo.2021.737996 Text en Copyright © 2021 Mo, Pan, Huang, Liang, Liao and Xia https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Mo, Manqiu
Pan, Ling
Huang, Zichun
Liang, Yuzhen
Liao, Yunhua
Xia, Ning
Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury
title Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury
title_full Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury
title_fullStr Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury
title_full_unstemmed Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury
title_short Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury
title_sort development and validation of a prediction model for survival in diabetic patients with acute kidney injury
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8727769/
https://www.ncbi.nlm.nih.gov/pubmed/35002952
http://dx.doi.org/10.3389/fendo.2021.737996
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