Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury

doi:10.3748/wjg.v28.i30.4133

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World Journal of Gastroenterology

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World J Gastroenterol. Aug 14, 2022; 28(30): 4133-4151
Published online Aug 14, 2022. doi: 10.3748/wjg.v28.i30.4133

Table 1 Demographic and baseline clinical characteristics of cirrhotic patients with acute kidney injury

Variables	Total (n = 250)	Training cohort (n = 173)	Validation cohort (n = 77)	P value
Age (yr), mean ± SD	53.6 ± 13.3	53.3 ± 13.1	54.4 ± 13.7	0.554
Male, n (%)	190 (76.0)	127 (73.4)	63 (81.8)	0.199
Heart rates > 100 bpm, n (%)	58 (23.2)	36 (20.8)	22 (28.6)	0.120
MAP (mmHg), mean ± SD	87.8 ± 13.9	89.2 ± 13.7	84.5 ± 13.9	0.013
Duration of hospitalization (d), median (IQR)	16.0 (8.0-28.0)	16.0 (9.0-33.5)	16 (8.0-23.5)	0.180
Etiology of cirrhosis				> 0.05
Hepatitis B, n (%)	174 (69.6)	124 (71.7)	50 (64.9)
Alcoholic liver disease, n (%)	16 (6.4)	9 (5.2)	7 (9.1)
Hepatitis B and alcoholic, n (%)	20 (8.0)	14 (8.1)	6 (7.8)
Other, n (%)	40 (16.0)	24 (13.9)	14 (18.2)
Diabetes, n (%)	25 (10.0)	17 (9.8)	8 (10.4)	0.527
Ascites, n (%)	239 (95.6)	168 (97.1)	71 (92.2)	0.083
Infections, n (%)	62 (24.8)	42 (24.3)	20 (25.9)	0.445
HE, n (%)	93 (37.2)	68 (39.3)	25 (32.5)	0.187
ACLF, n (%)	152 (60.8)	111 (64.2)	41 (53.2)	0.068
Previous esophagogastric variceal bleeding, n (%)	57 (22.8)	40 (23.1)	17 (22.1)	0.497
UO (mL/kg/h), mean ± SD	0.61 ± 0.39	0.53 ± 0.38	0.61 ± 0.41	0.130
WBC count (10⁹/L), mean ± SD	8.3 ± 6.2	8.0 ± 5.1	8.1 ± 6.8	0.853
Platelet count (10⁹/L), median (IQR)	75.5 (48.0-123.7)	73.0 (47.5-124.0)	77.0 (48.0-124.5)	0.623
Albumin (g/L), mean ± SD	28.6 ± 5.4	29.1 ± 5.3	27.5 ± 5.4	0.029
Total bilirubin (mg/dL), mean ± SD	14.6 ± 10.8	15.4 ± 10.8	12.6 ± 10.7	0.060
AST (U/L), median (IQR)	127.5 (63.7-280.7)	130 (65.5-262.5)	118.0 (56.5-304.0)	0.842
ALT (U/L), median (IQR)	76.0 (32.7-203.5)	76.0 (37.0-206.0)	76.0 (30.0-204.0)	0.904
INR, mean ± SD	2.0 ± 0.8	2.0 ± 0.7	2.1 ± 0.9	0.361
Serum sodium (mmol/L), mean ± SD	132.9 ± 5.7	132.3 ± 6.2	133.9 ± 4.8	0.024
Admission SCr (mg/dL), (IQR)	1.17 (0.8-1.8)	1.17 (0.80-1.75)	1.26 (0.77-1.79)	0.897
Peak SCr > 1.5 mg/dL during hospitalization, n (%)	211 (84.4)	148 (85.5)	63 (81.8)	0.283
HDL (mmol/L), mean ± SD	0.34 ± 0.33	0.36 ± 0.33	0.37 ± 0.31	0.857
LDL (mmol/L), mean ± SD	1.2 ± 1.0	1.2 ± 0.9	1.1 ± 1.1	0.783
CTP score, mean ± SD	10.6 ± 1.8	10.7 ± 1.8	10.4 ± 1.9	0.396
MELD, mean ± SD	23.6 ± 8.8	24.0 ± 8.2	22.7 ± 9.9	0.304
MELD-Na, mean ± SD	29.0 ± 13.0	30.1 ± 12.7	26.5 ± 13.3	0.044
Mortality within 180 d, n (%)	191.0 (76.4)	130 (75.1)	61 (79.2)	0.298
Period of follow up (d), median (IQR)	35.0 (17.0-143.0)	38.0 (18.0-151.0)	32.0 (15.0-119.0)	0.512

MAP: Mean arterial pressure; IQR: Interquartile range; bpm: Beat per minute; SCr: Serum creatinine; HE: Hepatic encephalopathy; INR: International normalized ratio; ACLF: Acute on chronic liver failure; WBC: White blood cell; UO: Urine output; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; CTP: Child-Turcotte-Pugh; MELD: The model for end-stage liver disease; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Table 2 Cox regression analysis of predictors for death of cirrhotic patients with acute kidney injury in the training cohort

Variable	Univariate			Multivariate
Variable	HR	95%CI	P value	HR	95%CI	P value
Age (≤ 60 vs > 60 yr)	1.003	0.989-1.017	0.670
Male (male vs female)	0.779	0.522-1.161	0.220
MAP (mmHg)	0.993	0.981-1.005	0.226
Heart rates (55 ≤ HR ≤ 100 vs HR > 100 bpm)	1.317	0.867-2.001	0.197
Etiology (viral hepatitis vs non-viral hepatitis)	0.897	0.521-1.248	0.335
Diabetes (absent vs present)	1.486	0.878-2.514	0.140	1.795	1.048-3.076	0.033
Previous esophagogastric variceal bleeding (absent vs present)	0.834	0.549-1.268	0.397
Ascites, (absent vs present)	1.594	0.507-5.012	0.425
Infections (absent vs present)	1.127	0.756-1.680	0.559
HE (absent vs present)	2.308	1.627-3.276	< 0.001	1.986	1.381-2.856	< 0.001
ACLF (absent vs present)	1.545	1.064-2.244	0.022
UO (mL/kg/h)	0.679	0.420-1.098	0.114
WBC count (10⁹/L)	1.018	0.987-1.050	0.264
Platelet count (10⁹/L)	1.000	0.998-1.003	0.805
Albumin (g/L)	1.001	0.971-1.032	0.963
Total bilirubin (≤ 4.0 vs > 4.0 mg/dL)	2.225	1.350-3.666	0.002
INR	1.625	1.282-2.061	< 0.001	1.390	1.081-1.787	0.010
Serum sodium (mmol/L)	0.957	0.933-0.982	0.001	0.964	0.937-0.992	0.011
Admission SCr (mg/dL)	1.121	0.975-1.289	0.109
Peak SCr (≤ 1.5 vs > 1.5 mg/dL)	2.407	1.326-4.371	0.004	2.026	1.109-3.702	0.022
HDL (mmol/L)	0.477	0.258-0.883	0.018
LDL (mmol/L)	0.871	0.696-1.090	0.227
CTP score	1.328	1.192-1.478	< 0.001
MELD score	1.057	1.034-1.082	< 0.001
MELD-Na score	1.036	1.022-1.050	< 0.001

HR: Hazard ratio; MAP: Mean arterial pressure; bpm: Beat per minute; SCr: Serum creatinine; HE: Hepatic encephalopathy; INR: International normalized ratio; ACLF: Acute on chronic liver failure; WBC: White blood cell; UO: Urine output; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; CTP: Child-Turcotte-Pugh; MELD: The model for end-stage liver disease; CI: Confidence interval.

Table 3 Comparison of models in predicting the death of cirrhotic patients with acute kidney injury

Datasets	Time of mortality	Predictive model	AUROC (95%CI)	P value
Training dataset	30-d	Nomogram	0.757 (0.685-0.830)	Ref.
		CTP	0.694 (0.616-0.772)	0.210
		MELD	0.669 (0.585-0.752)	0.114
		MELD-Na	0.702 (0.622-0.782)	0.332
Validation dataset	30-d	Nomogram	0.763 (0.656-0.869)	Ref.
		CTP	0.689 (0.569-0.809)	0.416
		MELD	0.745 (0.631-0.859)	0.979
		MELD-Na	0.763 (0.649-0.876)	> 0.05
Training dataset	90-d	Nomogram	0.792 (0.726-0.859)	Ref.
		CTP	0.696 (0.614 – 0.778)	0.041
		MELD	0.657 (0.574-0.740)	0.003
		MELD-Na	0.670 (0.586-0.755)	0.003
Validation dataset	90-d	Nomogram	0.817 (0.716-0.917)	Ref.
		CTP	0.667 (0.523-0.809)	0.031
		MELD	0.650 (0.515-0.785)	0.008
		MELD-Na	0.642 (0.502-0.783)	0.005
Training dataset	180-d	Nomogram	0.801 (0.726-0.870)	Ref.
		CTP	0.722 (0.630-0.814)	0.045
		MELD	0.663 (0.575-0.752)	0.008
		MELD-Na	0.680 (0.588-0.771)	0.009
Validation dataset	180-d	Nomogram	0.862 (0.765-0.958)	Ref.
		CTP	0.708 (0.540-0.878)	0.027
		MELD	0.659 (0.512-0.806)	0.002
		MELD-Na	0.652 (0.491-0.812)	0.002

CTP: Child-Turcotte-Pugh; MELD: The model for end-stage liver disease; AUROC: The area under the curve of the receiver operating characteristic curve; CI: Confidence interval.

Citation: Wan YP, Wang AJ, Zhang W, Zhang H, Peng GH, Zhu X. Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury. World J Gastroenterol 2022; 28(30): 4133-4151
URL: https://www.wjgnet.com/1007-9327/full/v28/i30/4133.htm
DOI: https://dx.doi.org/10.3748/wjg.v28.i30.4133