Development and validation of a nomogram for predicting acute kidney injury after orthotopic liver transplantation

Abstract

Background We aim to develop and validate a nomogram model for predicting severe acute kidney injury (AKI) after orthotopic liver transplantation (OLT). Methods A total of 576 patients who received OLT in our center were enrolled. They were assigned to the development and validation cohort according to the time of inclusion. Univariable and multivariable logistic regression using the forward variable selection routine were applied to find risk factors for post-OLT severe AKI. Based on the results of multivariable analysis, a nomogram was developed and validated. Patients were followed up to assess the long-term mortality and development of chronic kidney disease (CKD). Results Overall, 35.9% of patients were diagnosed with severe AKI. Multivariable logistic regression analysis revealed that recipients’ BMI (OR 1.10, 95% CI 1.04–1.17, p = 0.012), hypertension (OR 2.32, 95% CI 1.22–4.45, p = 0.010), preoperative serum creatine (sCr) (OR 0.96, 95% CI 0.95–0.97, p < 0.001), and intraoperative fresh frozen plasm (FFP) transfusion (OR for each 1000 ml increase 1.34, 95% CI 1.03–1.75, p = 0.031) were independent risk factors for post-OLT severe AKI. They were all incorporated into the nomogram. The area under the ROC curve (AUC) was 0.73 ( p < 0.05) and 0.81 ( p < 0.05) in the development and validation cohort. The calibration curve demonstrated the predicted probabilities of severe AKI agreed with the observed probabilities ( p > 0.05). Kaplan-Meier survival analysis showed that patients in the high-risk group stratified by the nomogram suffered significantly poorer long-term survival than the low-risk group (HR 1.92, p < 0.01). The cumulative risk of CKD was higher in the severe AKI group than no severe AKI group after competitive risk analysis (HR 1.48, p < 0.05). Conclusions With excellent predictive abilities, the nomogram may be a simple and reliable tool to identify patients at high risk for severe AKI and poor long-term prognosis after OLT.

A Novel Online Calculator Predicting Acute Kidney Injury After Liver Transplantation: A Retrospective Study

“…In the current study, we noted that AKI is a common issue for LT patients. According to the 2012 KDIGO criteria, we observed that the incidence of post-LT AKI in our center was 37.2%, which is slightly lower than the 40%–60% reported previously ( 4 , 5 , 7 , 8 ). However, compared with the other surgical population (e.g., orthopedic and gastrointestinal surgery), which was reported to vary from 2.9% to 11.8%, LT patients have a much higher postoperative AKI incidence.…”

“…Many studies have demonstrated that several intraoperative factors can significantly contribute to postoperative AKI ( 14 ), and electrolyte/acid-base balance disorder, hypotension, blood or FFP transfusion, lactate concentration and urine output have been associated with an increased incidence of AKI. ( 4 , 5 , 7 , 8 ) As we expected, two intraoperative risk factors (insulin dosage and anhepatic phase urine volume) were identified as independent predictors in this study. Regarding such intraoperative factors, clinicians can modify our intraoperative care and improve surgical procedures to reduce the risk of postoperative AKI.…”

“…The baseline serum creatinine was tested on the day before surgery. As any degree of AKI is associated with increased risk-adjusted mortality, we decided to include all stages of AKI in this study rather than only choosing severe AKI (stages 2 and 3), as previously reported ( 2 , 7 , 8 , 18 , 19 ). Hypertension and diabetes mellitus were defined according to standard criteria ( 20 , 21 ).…”

“…Acute kidney injury (AKI) is a frequent but severe complication after LT and is associated with increased morbidity (2,3). According to the current literature, which applied the 2012 Kidney Disease Improving Global Outcomes (KDIGO) criteria, the incidence of post-LT AKI is high, ranging from approximately 40%-60% (2,(4)(5)(6)(7)(8). For LT patients, there is no doubt that postoperative AKI is strongly associated with poor clinical outcomes, including increased graft rejection, longer hospital stay, more healthcare costs and shorter overall survival (2,3).…”

Risk prediction of the progression of chronic kidney disease stage 1 based on peripheral blood samples: construction and internal validation of a nomogram

“…According to studies, the prevalence of CKD is higher in people ≥65 years than in younger age group, and other risk factors for CKD such as heart disease, obesity, and previous kidney injury are also more common in older adults [ 40 ]. Patients with high BMI have more severe oxidative stress and endothelial dysfunction, and are less able to cope with stress renal hypoperfusion during surgery [ 41 ]. Family history of kidney disease shows varying effects on disease progression among people of different races and regions, which are closely related to social, economic, educational, and other factors [ 42 ].…”