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Development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study

BACKGROUND: Postoperative acute kidney injury (AKI) is associated with poor clinical outcomes. Early identification of high-risk patients of developing postoperative AKI can optimize perioperative renal management and facilitate patient survival. The present study aims to develop and validate a nomo...

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Autores principales: Yu, Yao, Zhang, Changsheng, Zhang, Faqiang, Liu, Chang, Li, Hao, Lou, Jingsheng, Xu, Zhipeng, Liu, Yanhong, Cao, Jiangbei, Mi, Weidong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756684/
https://www.ncbi.nlm.nih.gov/pubmed/35026992
http://dx.doi.org/10.1186/s12871-022-01566-z
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author Yu, Yao
Zhang, Changsheng
Zhang, Faqiang
Liu, Chang
Li, Hao
Lou, Jingsheng
Xu, Zhipeng
Liu, Yanhong
Cao, Jiangbei
Mi, Weidong
author_facet Yu, Yao
Zhang, Changsheng
Zhang, Faqiang
Liu, Chang
Li, Hao
Lou, Jingsheng
Xu, Zhipeng
Liu, Yanhong
Cao, Jiangbei
Mi, Weidong
author_sort Yu, Yao
collection PubMed
description BACKGROUND: Postoperative acute kidney injury (AKI) is associated with poor clinical outcomes. Early identification of high-risk patients of developing postoperative AKI can optimize perioperative renal management and facilitate patient survival. The present study aims to develop and validate a nomogram to predict postoperative AKI after liver resection in older patients. METHODS: A retrospective observational study was conducted involving data from 843 older patients scheduled for liver resection at a single tertiary high caseload general hospital between 2012 and 2019. The data were randomly divided into training (70%, n = 599) and validation (30%, n = 244) datasets. The training cohort was used to construct a predictive nomogram for postoperative AKI with the logistic regression model which was confirmed by a validation cohort. The model was evaluated by receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis in the validation cohort. A summary risk score was also constructed for identifying postoperative AKI patients. RESULTS: Postoperative AKI occurred in 155 (18.4%) patients and was highly associated with in-hospital mortality (5.2% vs. 0.7%, P <  0.001). The six predictors selected and assembled into the nomogram included age, preexisting chronic kidney disease (CKD), non-steroidal anti-inflammatory drugs (NSAIDs) usage, intraoperative hepatic inflow occlusion, blood loss, and transfusion. The predictive nomogram performed well in terms of discrimination with area under ROC curve (AUC) in training (0.73, 95% confidence interval (CI): 0.68–0.78) and validation (0.71, 95% CI: 0.63–0.80) datasets. The nomogram was well-calibrated with the Hosmer-Lemeshow chi-square value of 9.68 (P = 0.47). Decision curve analysis demonstrated a significant clinical benefit. The summary risk score calculated as the sum of points from the six variables (one point for each variable) performed as well as the nomogram in identifying the risk of AKI (AUC 0.71, 95% CI: 0.66–0.76). CONCLUSION: This nomogram and summary risk score accurately predicted postoperative AKI using six clinically accessible variables, with potential application in facilitating the optimized perioperative renal management in older patients undergoing liver resection. TRIAL REGISTRATION: NCT04922866, retrospectively registered on clinicaltrials.gov on June 11, 2021. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-022-01566-z.
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spelling pubmed-87566842022-01-18 Development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study Yu, Yao Zhang, Changsheng Zhang, Faqiang Liu, Chang Li, Hao Lou, Jingsheng Xu, Zhipeng Liu, Yanhong Cao, Jiangbei Mi, Weidong BMC Anesthesiol Research BACKGROUND: Postoperative acute kidney injury (AKI) is associated with poor clinical outcomes. Early identification of high-risk patients of developing postoperative AKI can optimize perioperative renal management and facilitate patient survival. The present study aims to develop and validate a nomogram to predict postoperative AKI after liver resection in older patients. METHODS: A retrospective observational study was conducted involving data from 843 older patients scheduled for liver resection at a single tertiary high caseload general hospital between 2012 and 2019. The data were randomly divided into training (70%, n = 599) and validation (30%, n = 244) datasets. The training cohort was used to construct a predictive nomogram for postoperative AKI with the logistic regression model which was confirmed by a validation cohort. The model was evaluated by receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis in the validation cohort. A summary risk score was also constructed for identifying postoperative AKI patients. RESULTS: Postoperative AKI occurred in 155 (18.4%) patients and was highly associated with in-hospital mortality (5.2% vs. 0.7%, P <  0.001). The six predictors selected and assembled into the nomogram included age, preexisting chronic kidney disease (CKD), non-steroidal anti-inflammatory drugs (NSAIDs) usage, intraoperative hepatic inflow occlusion, blood loss, and transfusion. The predictive nomogram performed well in terms of discrimination with area under ROC curve (AUC) in training (0.73, 95% confidence interval (CI): 0.68–0.78) and validation (0.71, 95% CI: 0.63–0.80) datasets. The nomogram was well-calibrated with the Hosmer-Lemeshow chi-square value of 9.68 (P = 0.47). Decision curve analysis demonstrated a significant clinical benefit. The summary risk score calculated as the sum of points from the six variables (one point for each variable) performed as well as the nomogram in identifying the risk of AKI (AUC 0.71, 95% CI: 0.66–0.76). CONCLUSION: This nomogram and summary risk score accurately predicted postoperative AKI using six clinically accessible variables, with potential application in facilitating the optimized perioperative renal management in older patients undergoing liver resection. TRIAL REGISTRATION: NCT04922866, retrospectively registered on clinicaltrials.gov on June 11, 2021. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12871-022-01566-z. BioMed Central 2022-01-13 /pmc/articles/PMC8756684/ /pubmed/35026992 http://dx.doi.org/10.1186/s12871-022-01566-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Yu, Yao
Zhang, Changsheng
Zhang, Faqiang
Liu, Chang
Li, Hao
Lou, Jingsheng
Xu, Zhipeng
Liu, Yanhong
Cao, Jiangbei
Mi, Weidong
Development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study
title Development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study
title_full Development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study
title_fullStr Development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study
title_full_unstemmed Development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study
title_short Development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study
title_sort development and validation of a risk nomogram for postoperative acute kidney injury in older patients undergoing liver resection: a pilot study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756684/
https://www.ncbi.nlm.nih.gov/pubmed/35026992
http://dx.doi.org/10.1186/s12871-022-01566-z
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