• Mingxia Li, Shuangping Zhao, Li Huang, Chenghuan Hu, Buyao Zhang, and Qinlan Hou.
• Department of Critical Care Medicine, Xiangya Hospital Central South University, Changsha, China.
• Curr Med Res Opin. 2022 Oct 1; 38 (10): 170517131705-1713.

ObjectivesApproximately one-third of patients with sepsis-associated acute kidney injury (AKI) progress to acute kidney disease (AKD) with higher short-term mortality. We aimed to identify the clinical characteristics that influence in-hospital death in sepsis-associated AKD and develop a nomogram to facilitate early warning.MethodsLogical regression was applied to screen variables based on clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. A nomogram was established to predict in-hospital death risk in patients with sepsis-associated AKD. The eICU Collaborative Research Database (eICU-CRD) was used for external validation. The receiver operating characteristic and calibration curves were used to determine the model's performance.ResultsA total of 1,779 patients with sepsis-associated AKD were included from the MIMIC-IV and 344 from the eICU-CRD. Age, Glasgow coma scale score, systolic blood pressure, peripheral oxygen saturation, platelet count, white blood cell count, and bicarbonate levels were significantly correlated with death. The nomogram demonstrated high discrimination in the training (C-index, 0.829; 95% confidence interval [CI] [0.807-0.852]) and testing sets (C-index: 0.760; 95% CI [0.706-0.814]). At the optimal cut-off value of 0.270, the model's sensitivity in the training and validation datasets was 72.8% (95% CI [68.3-76.9%]) and 64.5% (95% CI [54.9-73.4%]), while the specificity was 79.2% (95% CI [76.9-81.4%]) and 74.8% (95% CI [68.7-80.2%]), respectively.ConclusionWe identified seven predictors of in-hospital death in patients with sepsis-associated AKD. In addition, we developed an online dynamic nomogram to accurately and conveniently predict short-term outcomes, which performed well in the external dataset.

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