Analysis Of Risk Factors For Acute Kidney Injury After Surgery For Elderly Gastrointestinal Tumors And Construction Of Nomogram Model

Objective Acute kidney injury(AKI)is a common postoperative complication in elderly patients,but there are few studies on the risk factors and predictive model construction of postoperative AKI in elderly patients undergoing gastrointestinal tumors surgery.This study aimed to retrospectively analyze the risk factors for AKI in elderly patients undergoing gastrointestinal tumor surgery,create a risk prediction model,and construct a predictive nomogram.Methods This study retrospectively analyzed the data of elderly patients undergoing gastrointestinal tumor surgery from September 2018 to December 2021.Patients were divided into an AKI group(n=60)and a non-AKI group(n=267)according to whether acute kidney injury occurred after the operation.After univariate logistic analysis,factors with significant differences were included in multivariate logistic regression analysis to obtain independent risk factors for AKI.The risk prediction model of postoperative AKI was constructed,the receiver operating characteristic curve(ROC)was drawn according to the combined predictive value and the prediction nomogram was established according to the model.Through the Hosmer-Lemeshow goodness-of-fit test,the consistency index was calculated to evaluate the predictive ability of the model,and the calibration curve was drawn.Results Postoperative AKI occurred in 60 patients(18.35%).Multivariate logistic regression analysis showed that preoperative hypoproteinemia,mild anemia,moderate anemia,hypertension and coronary heart disease were independent risk factors for postoperative AKI.Logit(P)=-2.852 + 1.029 * hypoproteinemia(yes = 1,no = 0)+1.432 * degree of anemia(none = 0,mild = 1)or 1.125 * degree of anemia(none = 0,moderate = 2)+ 0.861 * hypertension(yes = 1,no = 0)+ 1.127 * coronary heart disease(yes = 1,no = 0),the area under the receiver operating characteristic(ROC)curve was0.75(95% CI 0.686～0.8145),the sensitivity was 73.30%,and the specificity was64.40%.According to the results of logistic regression analysis,the prediction nomogram was constructed,and the consistency index was calculated to be 0.75(95%CI 0.686～0.814).The slope of Calibration curve drawn at the same time is close to 1.Conclusion The incidence of postoperative AKI in elderly patients undergoing gastrointestinal tumor surgery was 18.35%.Hypoproteinemia,mild to moderate anemia,hypertension and coronary heart disease were independent risk factors for postoperative AKI.The predictive nomogram constructed according to the model has good guiding value for the clinical prediction of the occurrence of AKI after gastrointestinal tumors in elderly patients.