An early warning model to predict acute kidney injury in sepsis patients with prior hypertension

Zhuo Ma; Weifeng Liu; Fan Deng; Meichen Liu; Weijie Feng; Bingsha Chen; Cai Li; Ke Xuan Liu

doi:10.1016/j.heliyon.2024.e24227

An early warning model to predict acute kidney injury in sepsis patients with prior hypertension

Heliyon. 2024 Jan 10;10(2):e24227. doi: 10.1016/j.heliyon.2024.e24227. eCollection 2024 Jan 30.

Authors

Zhuo Ma¹, Weifeng Liu¹, Fan Deng¹, Meichen Liu¹, Weijie Feng¹, Bingsha Chen¹, Cai Li¹, Ke Xuan Liu¹

Affiliation

¹ The Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.

Abstract

Background: In the context of sepsis patients, hypertension has a significant impact on the likelihood of developing sepsis-associated acute kidney injury (S-AKI), leading to a considerable burden. Moreover, sepsis is responsible for over 50 % of cases of acute kidney injuries (AKI) and is linked to an increased likelihood of death during hospitalization. The objective of this research is to develop a dependable and strong nomogram framework, utilizing the variables accessible within the first 24 h of admission, for the anticipation of S-AKI in sepsis patients who have hypertension.

Methods: In this study that looked back, a total of 462 patients with sepsis and high blood pressure were identified from Nanfang Hospital. These patients were then split into a training set (consisting of 347 patients) and a validation set (consisting of 115 patients). A multivariate logistic regression analysis and a univariate logistic regression analysis were performed to identify the factors that independently predict S-AKI. Based on these independent predictors, the model was constructed. To evaluate the efficacy of the designed nomogram, several analyses were conducted, including calibration curves, receiver operating characteristics curves, and decision curve analysis.

Results: The findings of this research indicated that diabetes, prothrombin time activity (PTA), thrombin time (TT), cystatin C, creatinine (Cr), and procalcitonin (PCT) were autonomous prognosticators for S-AKI in sepsis individuals with hypertension. The nomogram model, built using these predictors, demonstrated satisfactory discrimination in both the training (AUC = 0.823) and validation (AUC = 0.929) groups. The S-AKI nomogram demonstrated superior predictive ability in assessing S-AKI within the hypertension grade I (AUC = 0.901) set, surpassing the hypertension grade II (AUC = 0.816) and III (AUC = 0.810) sets. The nomogram exhibited satisfactory calibration and clinical utility based on the calibration curve and decision curve analysis.

Conclusion: In patients with sepsis and high blood pressure, the nomogram that was created offers a dependable and strong evaluation for predicting S-AKI. This evaluation provides valuable insights to enhance individualized treatment, ultimately resulting in improved clinical outcomes.

Keywords: Acute kidney injury; Early warning; Hypertension; Nomogram; Sepsis.