A Visual Risk Assessment Tool For Acute Kidney Injury After Intracranial Aneurysm Clipping Surgery

Objective:Acute kidney injury(AKI)is a clinical syndrome characterized by persistent oliguria and elevated serum creatinine,its morbidity varies from the causes,while 40% of in-hospital AKI cases are related to surgical procedures.Considering there is rare curative treatment except for renal replacement therapy up to now,prevention of postoperative AKI should be paid more attention.Aneurysm clipping is a major surgical technique to treat intracranial aneurysm,but renal complications after intracranial aneurysm clipping was rarely noticed.The aim of the study was to establish a predictive postoperative nomogram for after intracranial aneurysm clipping surgery,in order to early identify patients with high postoperative AKI risk.Methods:This is a single-centerretrospective study,which included patients who underwent intracranial aneurysm clipping surgery in the Affiliated Hospital of Qingdao University.Clinical data of patients were retrospectively collected using medical data platform combined with electronic medical record.Multivariate logistic regression was employed to select confound factors that associated with AKI,then incorporated into the nomogram.The predictive accuracy of the model was assessed by concordance index(C-Index).Results: A total of 365 patients after intracranial aneurysm clipping surgery were enrolled in the study eventually,of which 68(18.63%)suffered postoperative AKI,and the incidence of stage 1,stage 2 and stage 3 were 92.65%(63/68),5.88%(4/68),and 1.47%(1/68),respectively.Univariate logistic regression revealed that high density lipoprotein(HDL),prothrombin time(PT),estimated glomerular filtration rate(e GFR),size of aneurysm ≥10 mm,and aneurysm ruptured before surgery were associated with AKI after surgery.Multivariate logistic regression showed that the size of aneurysm ≥10 mm and aneurysm ruptured were independent AKI risk factors while patients with higher EGFR,PT and HDL were less likely to suffer postoperative AKI.In addition,the nomogram demonstrated a good accuracy in estimating intracranial aneurysm clipping associated AKI,as a C-Index and a bootstrap-corrected one of 0.772 and 0.737 respectively.Moreover,calibration plots showed consistency with the actual presence of AKI.Conclusion:HDL,PT,e GFR,aneurysm ≥10mm and aneurysm ruptured before surgery were predictors of AKI after intracranial aneurysm clipping.Besides,the novel nomogram model can serve as a promising predictive tool to improve the identification of AKI among those who underwent intracranial aneurysm clipping surgery.