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Volume 15 Issue 1
Jan.  2024
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Article Navigation >  Medical Journal of Peking Union Medical College Hospital  > 2024  >  15(1): 89-98
OUYANG Jing, CHANG Hong, YANG Mengjiao, ZHANG Meng, TIAN Meng, ZHENG Ya, WANG Yuping, CHEN Zhaofeng. Establishment and Validation of A Prediction Model for the Occurrence of Acute Kidney Disease in Patients with Liver Cirrhosis[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(1): 89-98. doi: 10.12290/xhyxzz.2023-0394
Citation: OUYANG Jing, CHANG Hong, YANG Mengjiao, ZHANG Meng, TIAN Meng, ZHENG Ya, WANG Yuping, CHEN Zhaofeng. Establishment and Validation of A Prediction Model for the Occurrence of Acute Kidney Disease in Patients with Liver Cirrhosis[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(1): 89-98. doi: 10.12290/xhyxzz.2023-0394
shu

Establishment and Validation of A Prediction Model for the Occurrence of Acute Kidney Disease in Patients with Liver Cirrhosis

doi: 10.12290/xhyxzz.2023-0394
  • 1.

    The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China

  • 2.

    Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, China

  • 3.

    Gansu Clinical Research Center for Digestive Diseases, Lanzhou 730000, China

Funds:

National Natural Science Foundation of China 82260122

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  • Corresponding author: CHEN Zhaofeng, E-mail: zhfchen@lzu.edu.cn
  • Received Date: 2023-08-23
  • Accepted Date: 2023-10-09
  • Publish Date: 2024-01-30
    Abstract
  •   Objective  To establish a model that can predict the occurrence of acute kidney disease (AKD) in liver cirrhotic patients and evaluate its performance.  Methods  Liver cirrhotic patients who hospitalized in the department of gastroenterology of the First Hospital of Lanzhou University from January 2017 to January 2022 were retrospectively included. They were divided into AKD and non-AKD groups according to whether they were combined with AKD during hospitalization, and were randomized into training and validation sets in a 7∶3 ratio. The clinical data of patients in the two groups were collected, and LASSO regression and multifactorial Logistic regression were used to screen the influencing factors for the occurrence of AKD in patients with liver cirrhosis and to establish a prediction model. The model was then evaluated by using the receiver operating characteristic curve, the calibration curve and the clinical decision curve.  Results  A total of 796 cases of liver cirrhotic patients who met the inclusion and exclusion criteria were enrolled. Among them, 103 cases were in the AKD group and 693 cases were in the non-AKD group; 561 cases were in the training set and 235 cases were in the validation set. The results of LASSO regression and multifactorial Logistic regression showed that a history of diabetes (OR=2.922, 95% CI: 1.290-6.564, P=0.009), hepatic encephalopathy (OR=6.210, 95% CI: 2.278-17.479, P < 0.001), gastrointestinal bleeding (OR=2.501, 95% CI: 1.236-5.073, P=0.011), ascites (OR=3.219, 95% CI: 1.664-6.539, P < 0.001), male (OR=0.477, 95% CI: 0.254-0.879, P=0.019), hemoglobin (OR=0.987, 95% CI: 0.975-0.999, P=0.044), albumin (OR=0.952, 95% CI: 0.911-0.991, P=0.023), and prothrombin time (OR=0.865, 95% CI: 0.779-0.920, P < 0.001) were the independent influences on the occurrence of AKD in liver cirrhotic patients, and were used to construct a prediction model. The area under the curve of the model in the training set and validation set for predicting the occurrence of AKD in liver cirrhotic patients was 0.895 (95% CI: 0.865-0.925) and 0.869 (95% CI: 0.807-0.930), respectively. The calibration curves showed that the model had good fit and consistency and the clinical decision curves showed that the use of the model for predicting the risk of AKD could benefit liver cirrhotic patients overall.  Conclusions  A prediction model for the occurrence of AKD in liver cirrhotic patients was established based on eight influencing factors, including gender, history of diabetes, and hepatic encephalopathy. It was validated to have good discrimination, calibration, and clinical utility, and is expected to assist in the clinical early screening and identification of liver cirrhosis-associated AKD.
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    • References(32)
  • [1] Lei L, Li L P, Zeng Z, et al. Value of urinary KIM-1 and NGAL combined with serum Cys C for predicting acute kidney injury secondary to decompensated cirrhosis[J]. Sci Rep, 2018, 8(1): 7962. doi:  10.1038/s41598-018-26226-6
    [2] 孙海青, 娄金丽. 2015年至2016年首都医科大学附属北京佑安医院肝硬化和肝癌病人肾小球滤过率传染病学调查[J]. 首都医科大学学报, 2017, 38(4): 541-545. doi:  10.3969/j.issn.1006-7795.2017.04.011

    Sun H Q, Lou J L. Infectious diseases survey of estimated glomerular filtration rate in patients with liver cirrhosis and liver cancer of Beijing Youan Hospital, Capital Medical University from 2015 to 2016[J]. J Capit Med Univ, 2017, 38(4): 541-545. doi:  10.3969/j.issn.1006-7795.2017.04.011
    [3] 臧红, 刘婉姝, 刘鸿凌, 等. 急性肝衰竭并发急性肾损伤的危险因素及对近期预后的影响[J]. 中国肝脏病杂志(电子版), 2016, 8(4): 66-70.

    Zang H, Liu W S, Liu H L, et al. Risk factors and short-term outcomes of acute kidney injury in patients with acute liver failure[J]. Chin J Liver Dis (Electr Version), 2016, 8(4): 66-70.
    [4] 杨渝伟, 黄玉霞, 陈小红, 等. 胱抑素C及其eGFR方程在诊断肝硬化患者肾损害中的应用[J]. 现代检验医学杂志, 2016, 31(4): 24-29. doi:  10.3969/j.issn.1671-7414.2016.04.006

    Yang Y W, Huang Y X, Chen X H, et al. Clinical application of cystatin C and it's eGFR equation for diagnosing kidney injure in patients with liver cirrhosis[J]. J Mod Lab Med, 2016, 31(4): 24-29. doi:  10.3969/j.issn.1671-7414.2016.04.006
    [5] Piano S, Romano A, Di Pascoli M, et al. Why and how to measure renal function in patients with liver disease[J]. Liver Int, 2017, 37(Suppl 1): 116-122.
    [6] Chawla L S, Bellomo R, Bihorac A, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup[J]. Nat Rev Nephrol, 2017, 13(4): 241-257. doi:  10.1038/nrneph.2017.2
    [7] Angeli P, Garcia-Tsao G, Nadim M K, et al. News in pathophysiology, definition and classification of hepatorenal syndrome: a step beyond the International Club of Ascites (ICA) consensus document[J]. J Hepatol, 2019, 71(4): 811-822. doi:  10.1016/j.jhep.2019.07.002
    [8] Tonon M, Rosi S, Gambino C G, et al. Natural history of acute kidney disease in patients with cirrhosis[J]. J Hepatol, 2021, 74(3): 578-583. doi:  10.1016/j.jhep.2020.08.037
    [9] Kellum J A, Nadim M K. Acute kidney disease and cirrhosis[J]. J Hepatol, 2021, 74(3): 500-501. doi:  10.1016/j.jhep.2020.11.006
    [10] 赵晨玲, 董婷, 孙伦燕, 等. Wilson病脂代谢异常患者发生肝纤维化的列线图预测模型的建立与验证[J]. 南方医科大学学报, 2022, 42(11): 1720-1725. doi:  10.12122/j.issn.1673-4254.2022.11.17

    Zhao C L, Dong T, Sun L Y, et al. Establishment and validation of a predictive nomogram for liver fibrosis in patients with Wilson disease and abnormal lipid metabolism[J]. J South Med Univ, 2022, 42(11): 1720-1725. doi:  10.12122/j.issn.1673-4254.2022.11.17
    [11] Langham R G, Bellomo R, D'Intini V, et al. KHA-CARI guideline: KHA-CARI adaptation of the KDIGO Clinical Practice Guideline for Acute Kidney Injury[J]. Nephrology (Carlton), 2014, 19(5): 261-265. doi:  10.1111/nep.12220
    [12] Lameire N H, Levin A, Kellum J A, et al. Harmonizing acute and chronic kidney disease definition and classifica-tion: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference[J]. Kidney Int, 2021, 100(3): 516-526. doi:  10.1016/j.kint.2021.06.028
    [13] 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 传染病信息, 2017, 30(5): Ⅰ-ⅩⅦ.

    Hepatology Branch of the Chinese Medical Association. Diagnosis and treatment guidelines for ascites and related complications in liver cirrhosis[J]. Infect Dis Info, 2017, 30(5): Ⅰ-ⅩⅦ.
    [14] 郑华, 张萌, 赵泽, 等. 应用机器学习建立北京协和医院急性肾损伤预测模型: 单中心研究计划[J]. 协和医学杂志, 2021, 12(6): 913-921. doi:  10.12290/xhyxzz.2021-0519

    Zheng H, Zhang M, Zhao Z, et al. Establishing AKI warning system in Peking Union Medical College Hospital from a machine learning approach: a single-center research protocol[J]. Med J PUMCH, 2021, 12(6): 913-921. doi:  10.12290/xhyxzz.2021-0519
    [15] Nadim M K, Garcia-Tsao G. Acute kidney injury in patients with cirrhosis[J]. N Engl J Med, 2023, 388(8): 733-745. doi:  10.1056/NEJMra2215289
    [16] 龙泓伶. 乙肝肝硬化失代偿期患者发生急性肾损伤的危险因素分析[D]. 重庆: 重庆医科大学, 2020.

    Long H L. Analysis of risk factors of acute renal injury in patients with decompensated hepatitis B cirrhosis[D]. Chongqing: Chongqing Medical University, 2020.
    [17] Adebayo D, Morabito V, Davenport A, et al. Renal dysfunction in cirrhosis is not just a vasomotor nephropathy[J]. Kidney Int, 2015, 87(3): 509-515. doi:  10.1038/ki.2014.338
    [18] Appenrodt B, Lammert F. Renal failure in patients with liver cirrhosis: novel classifications, biomarkers, treatment[J]. Visc Med, 2018, 34(4): 246-252. doi:  10.1159/000492587
    [19] Inker L A, Levey A S, Pandya K, et al. Early change in proteinuria as a surrogate end point for kidney disease progression: an individual patient meta-analysis[J]. Am J Kidney Dis, 2014, 64(1): 74-85. doi:  10.1053/j.ajkd.2014.02.020
    [20] Chu R, Li C, Wang S X, et al. Assessment of KDIGO definitions in patients with histopathologic evidence of acute renal disease[J]. Clin J Am Soc Nephrol, 2014, 9(7): 1175-1182. doi:  10.2215/CJN.06150613
    [21] Wong F, Garcia-Tsao G, Reddy K R, et al. Prognosis of hospitalized patients with cirrhosis and acute kidney disease[J]. Liver Int, 2022, 42(4): 896-904. doi:  10.1111/liv.15154
    [22] Patidar K R, Naved M A, Grama A, et al. Acute kidney disease is common and associated with poor outcomes in patients with cirrhosis and acute kidney injury[J]. J Hepatol, 2022, 77(1): 108-115. doi:  10.1016/j.jhep.2022.02.009
    [23] 周乐, 郭兆安, 李伟. 糖尿病肾病足细胞损伤的表观遗传调控[J]. 肾脏病与透析肾移植杂志, 2020, 29(1): 60-65.

    Zhou L, Guo Z A, Li W. Epigenetic regulation of podocyte injury in diabetic nephropathy[J]. Chin J Nephrol, Dial Transpl, 2020, 29(1): 60-65.
    [24] 陈丹丹, 龙志达, 黄顺东, 等. 慢加急性乙型肝炎肝衰竭患者发生感染和急性肾损伤危险因素分析[J]. 实用肝脏病杂志, 2021, 24(5): 717-720. doi:  10.3969/j.issn.1672-5069.2021.05.028

    Chen D D, Long Z D, Huang S D, et al. Risk factors of infection and acute kidney injury in patients with acute-on-chronic hepatitis B liver failure[J]. J Pract Hepatol, 2021, 24(5): 717-720. doi:  10.3969/j.issn.1672-5069.2021.05.028
    [25] Papadopoulou-Marketou N, Chrousos G P, Kanaka-Gantenbein C. Diabetic nephropathy in type 1 diabetes: a review of early natural history, pathogenesis, and diagnosis[J]. Diabetes Metab Res Rev, 2017, 33(2): 2841. doi:  10.1002/dmrr.2841
    [26] Hadjihambi A, De Chiara F, Hosford P S, et al. Ammonia mediates cortical hemichannel dysfunction in rodent models of chronic liver disease[J]. Hepatology, 2017, 65(4): 1306-1318. doi:  10.1002/hep.29031
    [27] 贺勇, 李贵星, 夏勇. 肝肾综合征与血氨水平的关系[J]. 中华肝脏病杂志, 2010, 18(1): 45-48. doi:  10.3760/cma.j.issn.1007-3418.2010.01.011

    He Y, Li G X, Xia Y. Analysis of the relationship between hepatorenal syndrome and plasma ammonia[J]. Chin J Hepatol, 2010, 18(1): 45-48. doi:  10.3760/cma.j.issn.1007-3418.2010.01.011
    [28] 李琼, 毛小荣, 田爱平, 等. 乙肝肝硬化后慢加急性肝衰竭病人发生急性肾脏疾病的影响因素[J]. 西南医科大学学报, 2023, 46(1): 41-45.

    Li Q, Mao X R, Tian A P, et al. Influencing factors of AKD in patients with ACLF on the basis of hepatitis B cirrhosis[J]. J South Med Univ, 2023, 46(1): 41-45.
    [29] Andonovic M, Traynor J P, Shaw M, et al. Short- and long-term outcomes of intensive care patients with acute kidney disease[J]. EClinicalMedicine, 2022, 44: 101291. doi:  10.1016/j.eclinm.2022.101291
    [30] Heyman S N, Khamaisi M, Zorbavel D, et al. Role of hypoxia in renal failure caused by nephrotoxins and hypertonic solutions[J]. Semin Nephrol, 2019, 39(6): 530-542.
    [31] Karkouti K, Grocott H P, Hall R, et al. Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study[J]. Can J Anaesth, 2015, 62(4): 377-384.
    [32] James M T, Levey A S, Tonelli M, et al. Incidence and prognosis of acute kidney diseases and disorders using an integrated approach to laboratory measurements in a universal health care system[J]. JAMA Netw Open, 2019, 2(4): e191795.
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