Construction and evaluation of dynamic nomogram model prediction model for early acute renal injury risk after heart transplantation
10.12092/j.issn.1009-2501.2024.11.009
- VernacularTitle:心脏移植术后早期急性肾损伤风险的动态列线图预测模型构建和评价
- Author:
Ye CHEN
1
;
Yingshuo JIANG
;
Xinyue ZHU
;
Wenxin DU
;
Xin CHEN
;
Sheng LOU
;
Jian-guo SUN
;
Junrong ZHU
Author Information
1. 中国药科大学南京市第一医院药学部,南京 210006,江苏;南京医科大学附属南京医院(南京市第一医院)药学部,南京 210006,江苏
- Publication Type:Journal Article
- Keywords:
heart transplantation;
acute kidney injury;
prediction model;
dynamic nomogram
- From:
Chinese Journal of Clinical Pharmacology and Therapeutics
2024;29(11):1272-1279
- CountryChina
- Language:Chinese
-
Abstract:
AIM:To analyze and screen the risk factors for acute kidney injury(AKI)following heart transplantation(HT),and to establish a dynamic no-mograms prediction model to forecast early AKI af-ter HT.METHODS:A retrospective analysis was con-ducted on clinical data from HT recipients at Nan-jing First Hospital from October 2012 to June 2024.Patients were divided into AKI and non-AKI groups based on AKI occurrence within 7 days post-sur-gery,with a 8:2 ratio for training and testing sets.Lasso regression and multivariable logistic regres-sion were used to select influencing factors.A dy-namic nomogram model was visualized using R.In-ternal validation was performed using 1 000 boot-strap samples.Model accuracy and discrimination were evaluated using the area under the receiver operating characteristic curve(AUC-ROC),calibra-tion curves,and the Hosmer-Lemeshow goodness-of-fit test.The nomogram model was compared with the Cleveland score.RESULTS:The results of a multivariable logistic regression indicate that a his-tory of atrial fibrillation(OR=9.647,95％CI=1.961-47.470),vasoactive inotropic score(OR=1.094,95％CI=1.012-1.183),intraoperative transfusion of red blood cells or plasma(OR=10.200,95％CI=1.727-60.238),postoperative central venous pressure(OR=1.548,95％CI=1.186-2.021),and postoperative use of vancomycin(OR=25.082,95％CI=2.122-296.417)are independent risk factors for HT-AKI.The dynamic nomogram model achieved an AUC of 0.842(95％CI:0.676-0.971)in the test set,with a calibration plot showing a slope close to 1 and a Brier score of 0.173.The Hosmer-Lemeshow good-ness-of-fit test(x2=5.658,P=0.685)suggests good predictive performance of the model.Moreover,this model demonstrates superior discriminative ability compared to the Cleveland score.CONCLU-SION:This study identified preoperative,intraoper-ative,and postoperative risk factors influencing the occurrence of HT-AKI.The developed dynamic no-mogram model accurately identifies high-risk indi-viduals for early HT-AKI and is convenient for clini-cal use.
