Predictive model of acute kidney injury after spontaneous intracerebral hemorrhage: A multicenter retrospective study

Abstract

Background and objectives: Acute kidney injury is a common comorbidity in patients with intracerebral hemorrhage. Although there are predictive models to determine risk of AKI in patients in critical care or post-surgical scenarios or in general medical floors, there are no models that specifically determine the risk of AKI in patients with ICH.

Methods: Clinical features and laboratory tests were selected by previous studies and LASSO (least absolute shrinkage and selection operator) regression. We used multivariable logistic regression with a bidirectional stepwise method to construct ICH-AKIM (intracerebral hemorrhage-associated acute kidney injury model). The accuracy of ICH-AKIM was measured by the area under the receiver operating characteristic curve. The outcome was AKI development during hospitalization, defined as KDIGO (Kidney Disease: Improving Global Outcomes) Guidelines.

Results: From four independent medical centers, a total of 9649 patients with ICH were available. Overall, five clinical features (sex, systolic blood pressure, diabetes, Glasgow coma scale, mannitol infusion) and four laboratory tests at admission (serum creatinine, albumin, uric acid, neutrophils-to-lymphocyte ratio) were predictive factors and were included in the ICH-AKIM construction. The AUC of ICH-AKIM in the derivation, internal validation, and three external validation cohorts were 0.815, 0.816, 0.776, 0.780, and 0.821, respectively. Compared to the univariate forecast and pre-existing AKI models, ICH-AKIM led to significant improvements in discrimination and reclassification for predicting the incidence of AKI in all cohorts. An online interface of ICH-AKIM is freely available for use.

Conclusion: ICH-AKIM exhibited good discriminative capabilities for the prediction of AKI after ICH and outperforms existing predictive models.

Keywords: Intracerebral hemorrhage; acute kidney injury; predictive model.

Figure 1.

Flowchart illustrating participant selection into the derivation and validation cohorts. ICH: intracerebral hemorrhage.

Figure 2.

The online web-based calculator of the model for predicting AKI in patients with intracerebral hemorrhage (https://westchina-neurosurgery.shinyapps.io/aki_predictor/) AKI: acute kidney injury. SBP: systolic blood pressure; NLR: neutrophils-to-lymphocyte ratio; GCS: Glasgow Coma Scale.

Figure 3.

The area under Receiver Operating Characteristic Curve (AUC) in five cohorts. AUC: area under curve.