Dynamic nomogram for predicting acute kidney injury in patients with acute ischemic stroke: A retrospective study

Ganggui Zhu; Zaixiang Fu; Taian Jin; Xiaohui Xu; Jie Wei; Lingxin Cai; Wenhua Yu

doi:10.3389/fneur.2022.987684

Dynamic nomogram for predicting acute kidney injury in patients with acute ischemic stroke: A retrospective study

Front Neurol. 2022 Sep 13:13:987684. doi: 10.3389/fneur.2022.987684. eCollection 2022.

Authors

Ganggui Zhu¹, Zaixiang Fu², Taian Jin², Xiaohui Xu³, Jie Wei², Lingxin Cai², Wenhua Yu¹

Affiliations

¹ Department of Neurosurgery, Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
² Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
³ Department of Neurosurgery, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China.

Abstract

Background: This study sought to develop and validate a dynamic nomogram chart to assess the risk of acute kidney injury (AKI) in patients with acute ischemic stroke (AIS).

Methods: These data were drawn from the Medical Information Mart for Intensive Care III (MIMIC-III) database, which collects 47 clinical indicators of patients after admission to the hospital. The primary outcome indicator was the occurrence of AKI within 48 h of intensive care unit (ICU) admission. Independent risk factors for AKI were screened from the training set using univariate and multifactorial logistic regression analyses. Multiple logistic regression models were developed, and nomograms were plotted and validated in an internal validation set. Based on the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) to estimate the performance of this nomogram.

Results: Nomogram indicators include blood urea nitrogen (BUN), creatinine, red blood cell distribution width (RDW), heart rate (HR), Oxford Acute Severity of Illness Score (OASIS), the history of congestive heart failure (CHF), the use of vancomycin, contrast agent, and mannitol. The predictive model displayed well discrimination with the area under the ROC curve values of 0.8529 and 0.8598 for the training set and the validator, respectively. Calibration curves revealed favorable concordance between the actual and predicted incidence of AKI (p > 0.05). DCA indicates the excellent net clinical benefit of nomogram in predicting AKI.

Conclusion: In summary, we explored the incidence of AKI in patients with AIS during ICU stay and developed a predictive model to help clinical decision-making.

Keywords: MIMIC-III database; acute ischemic stroke; acute kidney injury; nomogram; retrospective study.