- 中国科技论文统计源期刊
- 中国科技核心期刊
| Citation: |
Xue Jing, Chen Da-wei, Wan Xin. Construction of a predictive model for acute kidney injury after acute ischemic stroke[J]. Journal of Clinical Nephrology, 2024, 24(6): 475-483. DOI: 10.3969/j.issn.1671-2390.2024.06.006
|
To explore the risk factors of acute kidney injury （AKI） through a predictive model in patients with acute ischemic stroke （AIS）.
From January 1, 2022 to December 31, 2023, a total of 708 AIS hospitalized patients were retrospectively recruited as training set. The least absolute shrinkage and selection operator regression model was utilized for optimizing the selection of clinical profiles. Multivariate Logistic regression analysis was performed for constructing a Nomogram prediction model. Receiver operating characteristic curve, area under curve （AUC）, calibration curve and decision curve analyses were utilized for evaluating the predictive value of the model. Bootstrap repeated sampling method was employed for internal validation. And 97 AIS inpatients from June 1, 2022 to May 31, 2023 at Stroke Center of Affiliated Sir Run Run Hospital, Nanjing Medical University were utilized for external validation.
Concurrent acute respiratory failure （OR = 3.104, 95%CI:1.276-7.759, P = 0.013）, elevated levels of blood urea nitrogen （OR = 1.099, 95%CI:1.012-1.215, P = 0.042）, D-dimer （OR = 1.027, 95%CI:1.003-1.554, P = 0.046） and monocyte count （OR = 2.229, 95%CI:1.119-4.941, P = 0.044）, dosing of antibiotics （OR = 3.770, 95%CI:1.608-9.549, P = 0.003） and diuretics （OR = 2.681, 95%CI:1.550-4.709, P＜0.001）, mechanical ventilation （OR = 4.616, 95%CI:2.101-10.283, P＜0.001） and mannitol （OR = 2.552, 95%CI:1.457-4.470, P = 0.001） were independent risk factors for AKI in AIS patients . The prediction model was constructed with the above 8 variables. AUC of the model was 0.877（95%CI:0.844-0.910） could reach 0.875（95%CI:0.844-0.911） and 0.798 （95%CI:0.679-0.917） in internal and external validations respectively. Calibration curve showed that the model was well-calibrated and decision curve analysis indicated that the model had some clinical practicability.
This study has constructed a novel risk prediction model for AKI after AIS. It is both convenient and effective.
| [1] |
2019 Stroke Collaborators GBD. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol,2021,20(10):795-820. DOI: 10.1016/S1474-4422(21)00252-0.
|
| [2] |
Ma QF, Li R, Wang LJ, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the Global Burden of Disease Study 2019[J]. Lancet Public Health,2021,6(12):e897-e906. DOI: 10.1016/S2468-2667(21)00228-0.
|
| [3] |
Cui P, McCullough LD, Hao JW. Brain to periphery in acute ischemic stroke: Mechanisms and clinical significance[J]. Front Neuroendocrinol,2021,63:100932. DOI: 10.1016/j.yfrne.2021.100932.
|
| [4] |
Zorrilla-Vaca A, Ziai W, Connolly ES Jr, et al. Acute kidney injury following acute ischemic stroke and intracerebral hemorrhage: a meta-analysis of prevalence rate and mortality risk[J]. Cerebrovasc Dis,2018,45(1/2):1-9. DOI: 10.1159/000479338.
|
| [5] |
Huang Y, Wan CJ, Wu GQ. Acute kidney injury after a stroke: a PRISMA-compliant meta-analysis[J]. Brain Behav,2020,10(9):e01722. DOI: 10.1002/brb3.1722.
|
| [6] |
Qureshi AI, Aslam H, Zafar W, et al. Acute kidney injury in acute ischemic stroke patients in clinical trials[J]. Crit Care Med,2020,48(9):1334-1339. DOI: 10.1097/CCM.0000000000004464.
|
| [7] |
Arnold J, Ng KP, Sims D, et al. Incidence and impact on outcomes of acute kidney injury after a stroke: a systematic review and meta-analysis[J]. BMC Nephrol,2018,19(1):283. DOI: 10.1186/s12882-018-1085-0.
|
| [8] |
Khatri M, Himmelfarb J, Adams D, et al. Acute kidney injury is associated with increased hospital mortality after stroke[J]. J Stroke Cerebrovasc Dis,2014,23(1):25-30. DOI: 10.1016/j.jstrokecerebrovasdis.2012.06.005.
|
| [9] |
Moustafa H, Schoene D, Altarsha E, et al. Acute kidney injury in patients with malignant middle cerebral artery infarction undergoing hyperosmolar therapy with mannitol[J]. J Crit Care,2021,64:22-28. DOI: 10.1016/j.jcrc.2021.02.007.
|
| [10] |
Kashani K, Ronco C. Acute kidney injury electronic alert for nephrologist: reactive versus proactive?[J]. Blood Purif,2016,42(4):323-328. DOI: 10.1159/000450722.
|
| [11] |
中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志,2018,51(9):666-682.DOI: 10.3760/cma.j.issn.1006-7876.2018.09.004.
Chinese Society of Neurology, Chinese Stroke Society. The Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol,2018,51(9):666-682. DOI: 10.3760/cma.j.issn.1006-7876.2018.09.004.
|
| [12] |
Kwah LK, Diong J. National institutes of health stroke scale (NIHSS)[J]. J Physiother,2014,60(1):61. DOI: 10.1016/j.jphys.2013.12.012.
|
| [13] |
Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale[J]. Lancet,1974,2(7872):81-84. DOI: 10.1016/s0140-6736(74)91639-0.
|
| [14] |
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury[J]. Nephron Clin Pract,2012,120(4):c179-c184. DOI: 10.1159/000339789.
|
| [15] |
Nadkarni GN, Patel AA, Konstantinidis I, et al. Dialysis requiring acute kidney injury in acute cerebrovascular accident hospitalizations[J]. Stroke,2015,46(11):3226-3231. DOI: 10.1161/STROKEAHA.115.010985.
|
| [16] |
Covic A, Schiller A, Mardare NG, et al. The impact of acute kidney injury on short-term survival in an Eastern European population with stroke[J]. Nephrol Dial Transplant,2008,23(7):2228-2234. DOI: 10.1093/ndt/gfm591.
|
| [17] |
Pande SD, Roy D, Khine AA, et al. Acute kidney injury without need for dialysis, incidence, its impact on long-term stroke survival and progression to chronic kidney disease[J]. BMJ Open,2022,12(5):e050743. DOI: 10.1136/bmjopen-2021-050743.
|
| [18] |
Lima HDN, Saibel T, Colato G, et al. The impact of acute kidney injury on fatality of ischemic stroke from a hospital-based population in Joinville, Brazil[J]. J Bras Nefrol,2019,41(3):323-329. DOI: 10.1590/2175-8239-JBN-2018-0215.
|
| [19] |
Xu ZP, Cheng BL, Fu SQ, et al. Coagulative biomarkers on admission to the ICU predict acute kidney injury and mortality in patients with septic shock caused by intra-abdominal infection[J]. Infect Drug Resist,2019,12:2755-2764. DOI: 10.2147/IDR.S218592.
|
| [20] |
Spring JL, Winkler A, Levy JH. The influence of various patient characteristics on D-dimer concentration in critically ill patients and its role as a prognostic indicator in the intensive care unit setting[J]. Clin Lab Med,2014,34(3):675-686. DOI: 10.1016/j.cll.2014.06.015.
|
| [21] |
Moskowitz MA, Lo EH, Iadecola C. The science of stroke: mechanisms in search of treatments[J]. Neuron,2010,67(2):181-198. DOI: 10.1016/j.neuron.2010.07.002.
|
| [22] |
Rabb H, Griffin MD, McKay DB, et al. Inflammation in AKI: current understanding, key questions, and knowledge gaps[J]. J Am Soc Nephrol,2016,27(2):371-379. DOI: 10.1681/ASN.2015030261.
|
| [23] |
Grams ME, Estrella MM, Coresh J, et al. Fluid balance, diuretic use, and mortality in acute kidney injury[J]. Clin J Am Soc Nephrol,2011,6(5):966-973. DOI: 10.2215/CJN.08781010.
|
| [24] |
Ghane Shahrbaf F, Assadi F. Drug-induced renal disorders[J]. J Renal Inj Prev,2015,4(3):57-60. DOI: 10.12861/jrip.2015.12.
|
| [25] |
Xie HL, Chen HP, Hu YL, et al. Clindamycin-induced acute kidney injury: large biopsy case series[J]. Am J Nephrol,2013,38(3):179-183. DOI: 10.1159/000354088.
|
| [26] |
Clifford KM, Selby AR, Reveles KR, et al. The risk and clinical implications of antibiotic-associated acute kidney injury: a review of the clinical data for agents with signals from the food and drug administration’s adverse event reporting system(FAERS) database[J]. Antibiotics,2022,11(10):1367. DOI:10.3390/antibiotics 11101367.
|
| [27] |
Aliberti S, Brambilla AM, Chalmers JD, et al. Phenotyping community-acquired pneumonia according to the presence of acute respiratory failure and severe sepsis[J]. Respir Res,2014,15(1):27. DOI: 10.1186/1465-9921-15-27.
|
| [28] |
Soto GJ, Frank AJ, Christiani DC, et al. Body mass index and acute kidney injury in the acute respiratory distress syndrome[J]. Crit Care Med,2012,40(9):2601-2608. DOI: 10.1097/CCM.0b013e3182591ed9.
|
| [29] |
Haneya A, Diez C, Philipp A, et al. Impact of acute kidney injury on outcome in patients with severe acute respiratory failure receiving extracorporeal membrane oxygenation[J]. Crit Care Med,2015,43(9):1898-1906. DOI: 10.1097/CCM.0000000000001141.
|
| [30] |
Hemlin M, Ljungman S, Carlson J, et al. The effects of hypoxia and hypercapnia on renal and heart function, haemodynamics and plasma hormone levels in stable COPD patients[J]. Clin Respir J,2007,1(2):80-90. DOI: 10.1111/j.1752-699X.2007.00031.x.
|
| [31] |
Kuiper JW, Groeneveld AB, Slutsky AS, et al. Mechanical ventilation and acute renal failure[J]. Crit Care Med,2005,33(6):1408-1415. DOI: 10.1097/01.ccm.0000165808.30416.ef.
|
| [32] |
Zhu GG, Fu ZX, Jin TA, et al. Dynamic nomogram for predicting acute kidney injury in patients with acute ischemic stroke: a retrospective study[J]. Front Neurol,2022,13:987684. DOI: 10.3389/fneur.2022.987684.
|
| [33] |
Liu SY, Li M, Yang YX, et al. A novel risk model based on white blood cell-related biomarkers for acute kidney injury prediction in patients with ischemic stroke admitted to the intensive care unit[J]. Front Med,2022,9:1043396 DOI: 10.3389/fmed.2022.1043396.
|
Supported by: Beijing Renhe Information Technology Co., Ltd. 
.png)
DownLoad: