Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2022; 28(30): 4133-4151
Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4133
Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury
Yi-Peng Wan, An-Jiang Wang, Wang Zhang, Hang Zhang, Gen-Hua Peng, Xuan Zhu
Yi-Peng Wan, An-Jiang Wang, Wang Zhang, Hang Zhang, Gen-Hua Peng, Xuan Zhu, Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang 331706, Jiangxi Province, China
Xuan Zhu, Biomolecular Research Laboratory, Jiangxi Clinical Research Center for Gastroenterology, Nanchang 331706, Jiangxi Province, China
Author contributions: Wan YP, Wang AJ and Zhang W equally contributed to this work; Wang AJ and Zhu X contributed to the concept; Wan YP, Wang AJ and Zhang W designed this study; Wan YP performed the manuscript writing; Zhang W performed data analysis; Zhang H and Peng GH contributed to samples collection and data collection and validation; Zhu X were clinical experts and performed the manuscript revision; all authors read and approved the final version of the manuscript.
Supported by the National Natural Science Foundation of China, No. 81960120 and No. 82160115.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Nanchang University (No. AF-SG-04-2.0).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of The First Affiliated Hospital of Nanchang University.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xuan Zhu, MD, Chief Doctor, Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Nanchang 331706, Jiangxi Province, China.
Received: February 7, 2022
Peer-review started: February 7, 2022
First decision: April 10, 2022
Revised: April 29, 2022
Accepted: July 22, 2022
Article in press: July 22, 2022
Published online: August 14, 2022
Research background

Acute kidney injury (AKI) is a life-threatening complication in cirrhotic patients and is closely associated with the prognosis of these patients. The mortality of AKI in patients with cirrhosis was as high as 80%. Therefore, the identification of patients with AKI at high risk of death is necessary to improve their prognosis.

Research motivation

The majority of studies have focused on investigating the risk factors for the development of AKI or establishing a risk score model for predicting the development of AKI. However, studies focused on identifying the potential risk factors for cirrhotic patients with AKI are scarce.

Research objectives

This study aimed to identify risk factors of mortality and establish a nomogram for predicting overall survival in cirrhotic patients with AKI.

Research methods

We included 250 eligible cirrhotic patients with AKI in this study. These patients were randomly divided into a training cohort and a validation cohort at a ratio of 2:1. Potential risk factors for death were investigated by performing a Cox regression analysis of the training cohort. A prognostic nomogram was developed and evaluated by calculating the area under the curve of the receiver operating characteristic curve, constructing a calibration curve and performing decision curve analysis.

Research results

The serum sodium level, international normalized ratio, peak serum creatinine level > 1.5 mg/dL, the presence of hepatic encephalopathy and diabetes were considered potential risk factors for death in cirrhotic patients with AKI. The nomogram based on these risk factors has a good performance in predicting the short-term prognosis of cirrhotic patients with AKI. The cutoff value of 98 for the nomogram score was used to stratify patients; patients were divided into low- and high-risk groups, and high-risk patients had a higher mortality rate.

Research conclusions

The nomogram was a practical tool to predict the short-term prognosis of patients with cirrhosis who were diagnosed with AKI, and assist clinicians in making clinical decisions.

Research perspectives

The reliability and practicability of nomogram must be validated by conducting prospective, large-scale and multicenter studies. Application programs or software that can be embedded in electronic medical systems will be developed to guide clinicians in the timely evaluation and treatment of these patients.