Establishment and analysis of the prognostic nomogram for sepsis-associated acute kidney injury in short-term

doi:10.3877/cma.j.issn.1674-1358.2020.06.006

Abstract

Abstract:

Objective

To investigate the influencing factors of short-term adverse prognosis in patients with sepsis complicated with acute kidney injury (SA-AKI), and to establish a personalized line chart model to predict the short-term adverse prognosis risk of patients with SA-AKI.

Methods

Total of 363 patients with sepsis who were admitted to the Emergency Intensive Care Unit of Chongqing Liangping District People’s Hospital from January 1st, 2017 to June 1st, 2019 were collected; Follow-ups were conducted by telephone or outpatient review, and patients were divided into survival group (251 cases) and death group (112 cases) based on their prognosis within 30 days. Single-factor and multi-factor Logistic regression were used to analyze the influencing factors of SA-AKI patients’ death within 30-day, and R software was used to establish a line chart model to predict the short-term adverse prognosis of SA-AKI.

Results

Univariate analysis showed that age (Z =-3.268, P = 0.005), fungal infection (χ² = 12.318, P = 0.002), APACHE Ⅱ score (t = 9.587, P = 0.001), SOFA score (t = 6.328, P = 0.001), AKI failure to diagnose in time (χ² = 12.587, P = 0.001), antithrombin Ⅲ (Z =-8.332, P = 0.001) and AKI (Z =-7.009, P = 0.00) stage may be associated risk factors for death in patients with acute concurrent renal injury in sepsis within 30 d. Multivariate Logistic regression analysis showed that age (65-79 years old: P = 0.041, OR = 3.573, 95%CI: 1.054-12.112; > 79 years old: P = 0.028, OR = 3.681, 95%CI: 1.215-11.984), fungal infection (P = 0.018, OR = 4.684, 95%CI: 1.356-15.367), APACHEⅡ score (P = 0.001, OR = 1.265, 95%CI: 1.164-1.532), SOFA score (P = 0.001, OR = 1.291, 95%CI: 1.117-1.532), antithrombin-Ⅲ (60%~80%: P = 0.001, OR = 1.291, 95%CI: 1.117-1.532; < 60%: P = 0.001, OR = 15.329, 95%CI: 4.387-55.321), and AKI stage (2 period: P = 0.022, OR = 2.998, 95%CI: 1.039-8.325; 3 period: P = 0.001, OR = 9.367, 95%CI: 5.235-22.327) were all independent related factors for death within 30 days of patients with SA-AKI. The collinear map model validation showed that its initial consistency index (C-index) was 0.943; After 1 000 internal verifications of the model, the consistency index (C-index) was 0.945. The calibration curve showed that the collinear map model had a good differentiation and consistency, which could provide targeted guidance for prognosis evaluation of patients with SA-AKI.

Conclusions

This study was based on 6 independent influence factors including age, fungal infection, APACHE Ⅱ score, SOFA score, antithrombin-Ⅲ and AKI stage, to construct an individualized line map model to predict the concurrent KAI risk of patients with SA, which could accurately predict the risk of short-term adverse prognosis of patients with SA-AKI.

Key words: Sepsis, Acute kidney injury, Risk factors, Prognosis, Nomogram

Hongwen Zhou, Jianjun Liu, Mingcui Liao, Guanghong Jiang, Lei Liu. Establishment and analysis of the prognostic nomogram for sepsis-associated acute kidney injury in short-term[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(06): 473-479.

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References 29

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影响因素		死亡组（251例）	存活组（112例）	统计量	P值
年龄[例（%）]				Z =-3.268	0.005
	< 65岁	72（28.68）	42（37.50）
	65～79岁	104（41.44）	54（48.22）
	> 79岁	75（29.88）	16（14.28）
男性[例（%）]		172（68.53）	70（62.50）	χ² = 0.317	0.602
高血压[例（%）]		145（57.77）	45（40.18）	χ² = 0.318	0.637
糖尿病[例（%）]		47（18.73）	9（8.04）	χ² = 0.031	0.758
充血性心力衰竭[例（%）]		22（8.76）	10（8.93）	χ² = 0.538	0.364
慢性阻塞性肺疾病[例（%）]		32（12.75）	20（17.86）	χ² = 0.103	0.618
肝硬化[例（%）]		7（2.79）	8（7.14）	χ² = 0.045	0.831
恶性肿瘤[例（%）]		45（17.93）	23（20.54）	χ² = 0.485	0.437
真菌感染[例（%）]		63（25.10）	11（9.82）	χ² = 12.318	0.002
脓毒性休克[例（%）]		48（19.12）	19（21.96）	χ² = 0.444	0.528
机械通气[例（%）]		195（77.69）	82（73.21）	χ² = 0.698	0.401
肾脏替代治疗[例（%）]		62（24.70）	19（16.96）	χ² = 0.235	0.657
APACHE Ⅱ评分（ ± s）		30.04 ± 8.21	16.38 ± 5.21	t = 9.587	0.001
SOFA评分（ ± s）		10.23 ± 2.68	8.36 ± 3.15	t = 6.328	0.001
未及时诊断AKI [例（%）]		125（49.80）	30（26.79）	χ² = 12.587	0.001
血红蛋白（ ± s，g/L）		112.34 ± 20.36	113.21 ± 22.21	t =-1.002	0.247
白细胞（ ± s，× 10⁹/L）		10.89 ± 4.38	11.57 ± 5.36	t =-1.231	0.200
血小板计数（ ± s，× 10⁹/L）		148.56 ± 85.23	165.00 ± 90.41	t =-1.128	0.220
白蛋白（ ± s，g/L）		29.27 ± 6.37	29.56 ± 6.34	t =-1.003	0.294
抗凝血酶Ⅲ [例（%）]				Z =-8.332	0.001
	> 80%	58（23.20）	70（62.50）
	60%～80%	90（35.86）	30（26.79）
	< 60%	103（41.04）	12（10.71）
超敏C反应蛋白（± s，mg/L）		128.27 ± 78.25	120.49 ± 79.04	t = 0.804	0.422
AKI分期[例（%）]				Z =-7.009	0.001
	1期	33（13.15）	62（55.36）
	2期	53（21.12）	25（22.32）
	3期	165（65.73）	25（22.32）

影响因素		死亡组（251例）	存活组（112例）	统计量	P值
年龄[例（%）]				Z =-3.268	0.005
	< 65岁	72（28.68）	42（37.50）
	65～79岁	104（41.44）	54（48.22）
	> 79岁	75（29.88）	16（14.28）
男性[例（%）]		172（68.53）	70（62.50）	χ² = 0.317	0.602
高血压[例（%）]		145（57.77）	45（40.18）	χ² = 0.318	0.637
糖尿病[例（%）]		47（18.73）	9（8.04）	χ² = 0.031	0.758
充血性心力衰竭[例（%）]		22（8.76）	10（8.93）	χ² = 0.538	0.364
慢性阻塞性肺疾病[例（%）]		32（12.75）	20（17.86）	χ² = 0.103	0.618
肝硬化[例（%）]		7（2.79）	8（7.14）	χ² = 0.045	0.831
恶性肿瘤[例（%）]		45（17.93）	23（20.54）	χ² = 0.485	0.437
真菌感染[例（%）]		63（25.10）	11（9.82）	χ² = 12.318	0.002
脓毒性休克[例（%）]		48（19.12）	19（21.96）	χ² = 0.444	0.528
机械通气[例（%）]		195（77.69）	82（73.21）	χ² = 0.698	0.401
肾脏替代治疗[例（%）]		62（24.70）	19（16.96）	χ² = 0.235	0.657
APACHE Ⅱ评分（ ± s）		30.04 ± 8.21	16.38 ± 5.21	t = 9.587	0.001
SOFA评分（ ± s）		10.23 ± 2.68	8.36 ± 3.15	t = 6.328	0.001
未及时诊断AKI [例（%）]		125（49.80）	30（26.79）	χ² = 12.587	0.001
血红蛋白（ ± s，g/L）		112.34 ± 20.36	113.21 ± 22.21	t =-1.002	0.247
白细胞（ ± s，× 10⁹/L）		10.89 ± 4.38	11.57 ± 5.36	t =-1.231	0.200
血小板计数（ ± s，× 10⁹/L）		148.56 ± 85.23	165.00 ± 90.41	t =-1.128	0.220
白蛋白（ ± s，g/L）		29.27 ± 6.37	29.56 ± 6.34	t =-1.003	0.294
抗凝血酶Ⅲ [例（%）]				Z =-8.332	0.001
	> 80%	58（23.20）	70（62.50）
	60%～80%	90（35.86）	30（26.79）
	< 60%	103（41.04）	12（10.71）
超敏C反应蛋白（± s，mg/L）		128.27 ± 78.25	120.49 ± 79.04	t = 0.804	0.422
AKI分期[例（%）]				Z =-7.009	0.001
	1期	33（13.15）	62（55.36）
	2期	53（21.12）	25（22.32）
	3期	165（65.73）	25（22.32）

影响因素		β值	S.E.值	Wald值	P值	OR值	95%CI
年龄
	< 65岁					1
	65～79岁	1.327	0.601	5.371	0.041	3.573	1.054～12.112
	> 79岁	1.335	0.562	5.179	0.028	3.681	1.215～11.984
真菌感染		1.564	0.636	5.964	0.018	4.684	1.356～15.367
APACHE Ⅱ评分		0.239	0.043	35.132	0.001	1.265	1.164～1.532
SOFA评分		0.223	0.065	13.325	0.001	1.291	1.117～1.532
未及时诊断AKI		0.538	0.440	1.573	0.223	1.370	0.712～5.723
抗凝血酶Ⅲ
	> 80%					1
	60%～80%	1.563	0.654	6.954	0.006	4.325	2.351～13.218
	< 60%	2.385	0.564	30.215	0.001	15.329	4.387～55.321
AKI分期
	1期					1
	2期	1.103	0.630	3.117	0.022	2.998	1.039～8.325
	3期	2.842	0.428	19.256	0.001	9.367	5.235～22.327

影响因素		β值	S.E.值	Wald值	P值	OR值	95%CI
年龄
	< 65岁					1
	65～79岁	1.327	0.601	5.371	0.041	3.573	1.054～12.112
	> 79岁	1.335	0.562	5.179	0.028	3.681	1.215～11.984
真菌感染		1.564	0.636	5.964	0.018	4.684	1.356～15.367
APACHE Ⅱ评分		0.239	0.043	35.132	0.001	1.265	1.164～1.532
SOFA评分		0.223	0.065	13.325	0.001	1.291	1.117～1.532
未及时诊断AKI		0.538	0.440	1.573	0.223	1.370	0.712～5.723
抗凝血酶Ⅲ
	> 80%					1
	60%～80%	1.563	0.654	6.954	0.006	4.325	2.351～13.218
	< 60%	2.385	0.564	30.215	0.001	15.329	4.387～55.321
AKI分期
	1期					1
	2期	1.103	0.630	3.117	0.022	2.998	1.039～8.325
	3期	2.842	0.428	19.256	0.001	9.367	5.235～22.327

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