Wan et al reported a nomogram for predicting survival for a patient with cirrhosis and acute kidney injury (AKI). This can identify a patient who may require more aggressive management. The authors are from Nanchang University and Jiangxi Clinical Research Center for Gastroenterology.
Patient selection: cirrhosis with acute kidney injury
Parameters:
(1) diabetes
(2) grade of hepatic encephalopathy from 0 to 4
(3) INR from 0.5 to 6
(4) peak serum creatinine in mg/dL
(5) serum sodium in mmol/L
points for INR =
= (18.18 * (INR)) - 9.09
points for serum sodium =
= 288.26 - (1.92 * (sodium))
|
Parameter
|
Finding
|
Points
|
|
diabetes
|
no
|
0
|
|
|
yes
|
22.1
|
|
grade of hepatic encephalopathy
|
0
|
0
|
|
|
1
|
20.8
|
|
|
2
|
30
|
|
|
3
|
36.1
|
|
|
4
|
65.9
|
|
peak serum creatinine
|
< 1.5 mg/dL
|
0
|
|
|
2
|
11.6
|
|
|
3
|
39.9
|
|
|
4
|
45.7
|
|
|
>4
|
54.9
|
where:
• Serum creatinine handling does not specify decimal place handling.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 319.8
value of X =
= (-0.0002022* ((score)^2)) + (0.001154 * (score)) + 1.368
probability of 90 day survival =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.79 for derivation and 0.82 for validation cohorts for the 90-day predictions.
