A Prediction Nomogram for Acute Kidney Injury in Very-Low-Birth-Weight Infants: A Retrospective Study

Abstract

Background and objective: Acute kidney injury (AKI) is recognized as an independent predictor for mortality in very-low-birth-weight (VLBW) infants and is reported to have a high incidence. In this study, we sought to identify the predictors for AKI in VLBW infants and thereby develop a prediction nomogram for the early detection and management of VLBW infants at high risk of developing AKI.Methods: We designed a retrospective study wherein we investigated the baseline hospitalization data of VLBW infants treated at our hospital between January 2012 and October 2018. Independent predictors of AKI in VLBW infants, as identified by multivariate logistic regression, were incorporated into a model. Hosmer–Lemeshow test was used to test the goodness of fit of the model, and a receiver operating characteristic (ROC) curve was plotted to assess the discriminative ability of the model. The model was internally validated using the 10-fold cross-validation method. A nomogram was plotted to predict the risk of AKI in VLBW infants on the basis of the results of multivariate logistic regression analysis.Results: We investigated the data of 604 VLBW infants, of which 144 (23.8%) developed AKI; in 111 (77.1%) of these infants, AKI occurred within 7 days of birth. Multivariate logistic regression analysis identified the following as predictive factors for AKI in VLBW infants: gestational age, red blood cell count within 3 days of birth, serum calcium concentration within 3 days of birth, maternal age of ≥35 years, and pulmonary arterial hypertension or myocardial injury. Furthermore, the nomogram was found to be effective in estimating the risk of AKI in VLBW infants, with an area under the curve (AUC) of 0.794 [95% confidence interval (CI): 0.754–0.834; P < 0.001]. Internal validation done by cross-validation showed that the average AUC was 0.788.Conclusion: The nomogram developed in this study was found to be sensitive and specific for the preoperative prediction of AKI in VLBW infants, as per the Kidney Disease: Improving Global Outcomes (KDIGO) criteria modified for neonates.

Risk factors of acute kidney injury in very low birth weight infants in a tertiary neonatal intensive care unit

“…The increase in mortality in patients with AKI has been reported in other studies in the neonatal population, regardless of the AKI definition, gestational age, birth weight, and associated pathologies 1 , 3 , 4 , 10 , 14 as well as the longer need for mechanical ventilation. 4 , 14 , 15 …”

“…However, only a few focused on VLBW newborns, with different criteria to define AKI among them. 2 , 3 , 7 , 13 , 14 , 15 In developing countries, such as Brazil, it is of great importance to know the risk factors for AKI in VLBW newborns, to improve its diagnosis and management in the NICU to minimize sequelae. Moreover, a wide variation in the attainment of serum creatinine in different centers resulted in an incidence of AKI varying from 3 to 74% in a multicenter study, 1 enlightening the importance of knowing the local incidence and associated risk factors.…”

Human Stem Cell and Organoid Models to Advance Acute Kidney Injury Diagnostics and Therapeutics

“…Advancements in modern medicine have resulted in increased survival of extreme preterm infants (<28 weeks of gestation) who are born with lower nephron endowment and consequently lower kidney reserve. These baseline characteristics combined with common cardiovascular abnormalities (e.g., Patent Ductus Arteriosus), high exposure to nephrotoxic medications, and poor nutrition, greatly increase their renal vulnerability and consequently their risk for development of AKI, estimated to be as high as 25-48% in recent cohorts [49][50][51][52][53][54]. iPSC-derived kidney organoids, which can reach a degree of maturation equivalent to kidneys at the second trimester of human gestation, in congruence with cell specific CRISPR/Cas induced reporters, offer a unique window into the specific effects of insults to the developing human kidney and may reveal potential personalized targets for therapeutic intervention and kidney regeneration in this highly vulnerable patient population.…”

Inflammatory response biomarkers nomogram for predicting pneumonia in patients with spontaneous intracerebral hemorrhage

“…This study established a predictive nomogram as a simple statistical visualization tool to predict disease onset, progression, prognosis, and survival (17)(18)(19). This study aimed to assess whether inflammatory response biomarkers on admission contribute to the early prediction of SAP after SICH.…”