OBJECTIVES Acute kidney injury (AKI) is a common complication in hospitalized patients with cirrhosis which contributes to morbidity and mortality. Improved prediction of AKI in this population is needed for prevention and early intervention. We developed a model to identify hospitalized patients at risk for AKI. METHODS Admission data from a prospective cohort of hospitalized patients with cirrhosis without AKI on admission (n = 397) was used for derivation. AKI development in the first week of admission was captured. Independent predictors of AKI on multivariate logistic regression were used to develop the prediction model. External validation was performed on a separate multicenter cohort (n = 308). RESULTS In the derivation cohort, the mean age was 57 years, the Model for End-Stage Liver Disease score was 17, and 59 patients (15%) developed AKI after a median of 4 days. Admission creatinine (OR: 2.38 per 1 mg/dL increase [95% CI: 1.47-3.85]), international normalized ratio (OR: 1.92 per 1 unit increase [95% CI: 1.92-3.10]), and white blood cell count (OR: 1.09 per 1 × 10/L increase [95% CI: 1.04-1.15]) were independently associated with AKI. These variables were used to develop a prediction model (area underneath the receiver operator curve: 0.77 [95% CI: 0.70-0.83]). In the validation cohort (mean age of 53 years, Model for End-Stage Liver Disease score of 16, and AKI development of 13%), the area underneath the receiver operator curve for the model was 0.70 (95% CI: 0.61-0.78). DISCUSSION A model consisting of admission creatinine, international normalized ratio, and white blood cell count can identify patients with cirrhosis at risk for in-hospital AKI development. On further validation, our model can be used to apply novel interventions to reduce the incidence of AKI among patients with cirrhosis who are hospitalized.

中文翻译：

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肝硬化住院患者急性肾脏损伤预测模型的开发和验证。

目的急性肾损伤（AKI）是肝硬化住院患者的常见并发症，会增加发病率和死亡率。为了预防和及早干预，需要对该人群中的AKI进行更好的预测。我们开发了一种模型来识别有AKI风险的住院患者。方法采用前瞻性队列研究的住院患者（入院时无AKI）（n = 397）的入院数据进行推导。入院第一周的AKI发育情况被捕获。AKI在多因素logistic回归上的独立预测变量用于建立预测模型。外部验证是在单独的多中心队列中进行的（n = 308）。结果在派生队列中，平均年龄为57岁，终末期肝病模型得分为17。中位4天后，有59例患者（15％）出现了AKI。肌酐入院（OR：每增加1 mg / dL 2.38 [95％CI：1.47-3.85]），国际标准化比率（OR：每增加1个单位1.92 [95％CI：1.92-3.10]）和白细胞计数（或：每增加1×10 / L 1.09 [95％CI：1.04-1.15]）与AKI独立相关。这些变量用于建立预测模型（接收者操作员曲线下方的区域：0.77 [95％CI：0.70-0.83]）。在验证队列中（平均年龄为53岁，模型为终末期肝病模型，得分为16，AKI发生率为13％），模型的接收者操作符曲线下方的面积为0.70（95％CI：0.61-0.78） ）。讨论由入库肌酐，国际标准化比率，和白细胞计数可以识别出有肝硬化风险的院内AKI患者。经过进一步验证，我们的模型可用于应用新型干预措施以减少住院的肝硬化患者中AKI的发生率。