| Background:In the neurological/neurosurgical critical care unit(NCCU)or neurological/neurosurgical intensive care unit(NICU),acute kidney injury(AKI)is a common and serious complication which will increase mortality and disability rates.In the treatment of diseases,AKI will limit the application of osmotic diuretics,resulting in fluid imbalances;it will limit the application of antibiotics which are metabolized via the kidney and have potential nephrotoxicity,resulting in the infection being hard to cure;and it will limit the application of proton-pump inhibitors,because some studies showed these drugs could cause kidney dysfunction.Neurosurgery often requires the application of dehydration,anti-infection and proton pump inhibitors,which may cause treatment difficulties and increase mortality and disability rates.Considering the serious consequences of acute kidney injury,it is necessary to explore new methods for the prediction,diagnosis and treatment of acute kidney injury.Method:This is a retrospective study,collecting clinical parameters of all NICU patients from January 2017 to December 2017,including medical history,clinical symptoms,laboratory examination results,imaging examination results and doctors’prescription.At first,we performed simple univariate analyses,and then LASSO regression(Least Absolute Shrinkage and Selection Operator)was approached to further select variables.After that,logistic regression was performed to explain the selected variables via their coefficients,so that independent risk factors could be identified.Based on the results of multivariate analyses,a nomogram was drawn to evaluate the likelihood of AKI.Meanwhile,the predictive ability of the above models were tested.Results:1.Univariate Analysis:Patient data,from January 2017 to December 2017,were collected and divided into two groups according to whether AKI occurred within a month after addmission,Group AKI and Group non-AKI.Clinical profiles were compared between the two groups.Statistical differences were observed in age,major diagnosis,history of hypertension,history of coronary heart disease(P<0.05).Hospital-acquired complications such as pneumonia,liver dysfunction,hypoproteinemia,electrolyte disturbance,coagulation disorders,anemia and heart failure also had statistical differences between two groups(P<0.05).The significant differences could be observed in GCS,GCS classification and GCS 7-day-gap as well(P<0.05).In the first week after admission,the intake and output volume,systolic pressure,diastolic pressure,the CV of GCS were all significantly different between AKI and non-AKI(P<0.05).In addition,there were also some other significant differences in 7 days of lung infection(pneumonia),heart failure,surgery within 7 days or mechanical ventilation within 7 days(P<0.05).1)Laboratory test result(Baseline)Baseline result was considered as the first result of the major tests which came out from the first three days after admission.The significant differences could be observed in(P<0.05)indicators of ALP(Alkaline Phosphatase),PLT(Platelet),K~+(Potassium concentration)(P<0.05).2)MedicineSignificant differences can be observed in midazolam,meropenem,piperacillin sodium tazobactam sodium,cefoperazone sodium sulbactam sodium,furosemide,torasemide,dopamine,norepinephrine,epinephrine,diltiazem and urapidil(P<0.05).2.Multivariate analysis:In the beginning,LASSO regression was employed for the purposes of further variate-selection after univariate analyses.Logistic regression was performed to confirm the association of AKI and selected varieties.The results given by logistic regression were GCS classification(1.593;95%CI:0.995–2.549;P=0.0523),CV of GCS(1.017;95%CI:0.995–1.04;P=0.1367),hypertension(2.238;95%CI:1.124–4.456;P=0.0219),coronary heart disease(2.924;95%CI:1.2–7.126;P=0.0182),pneumonia within 7 days(3.032;95%CI:1.511–6.085;P=0.0018),heart failure within 7 days(6.589;95%CI:2.235–19.42;P=0.0006),furosemide(1.011;95%CI:1.005–1.016;P<0.0001),torasemide(1.028;95%CI:0.976–1.082;P=0.297),dopamine(1;95%CI:1–1.001,P=0.3297),and norepinephrine(1.007;95%CI:1–1.015;P=0.0474).3.Validation:The receiver operating characteristic(ROC)was drawn and the area under the curve(AUC)was calculated.The results indicated that the discrimination was good(AUC=0.8786).Calibration curves(CC)were used to evaluate the consistency of the results.These suggested that the model consistency was good.The results of the Hosmer-Lemeshow test showed a satisfactory fit(χ2=4.4175&P-value=0.8176).Conclusions:Our study pointed that AKI patients are generally older and with a higher mortality and longer NICU stays.In addition,they have greater past medical history(PMS),compared with patients without AKI.There are 10 risk factors which were highlighted by multivariate analyses.Our study also presents a predictive nomogram based on these results.The clinical use of the nomogram may allow for the timely detection of AKI occurrence and thus improve the prognosis of patients. |
