Development and validation of a nomogram to predict acute kidney injury in patients undergoing Cox Maze Ⅲ procedure
Objective The study is aimed to identify the risk factors of acute kidney injury(AKI)in patients undergoing the Cox Maze Ⅲ procedure,and establish a nomogram to predict the acute kidney injury.Methods The clinical data of patients who un-derwent Cox Maze Ⅲ procedure in Genaral Hospital of Eastern Theater Command from October 2015 to January 2023 were retrospec-tively studied.According to the occurrence of AKI after surgery,patients were divided into normal renal function group and AKI group.The differences in clinical data between the two groups were compared by univariate and multivariate analysis.A nomogram was estab-lished with these risk factors.Then,the established nomogram was verified by depicting the receiver operating characteristic(ROC)curves,calibration curve and decision curve.Results A total of 152 patients undergoing the Cox Maze Ⅲ procedure were included,of which 80(52.6％)patients developed into AKI,and 10(6.6％)patients required continuous renal replacement therapy(CRRT).Multivariate logistic regression analysis showed that female,age,diabetes mellitus,use of contrast media within 1 week before the surgery,NYHA≥level 3,cardiopulmonary bypass time≥160 min,and maximum lactate were independent risks of AKI(P＜0.05).The area under curve(AUC)of ROC in the established nomogram was 0.858(95％CI:0.800-0.915).Depicted calibration curve demonstrated a well-fitted prediction and observation probability.In addition,the decision curve analysis concluded that the newly established nomogram is significant for clinical decision-making.Conclusion There is a high incidence of AKI in patients undergoing the Cox Maze Ⅲ procedure.This no-mogram based on female,age,diabetes mellitus,use of contrast media within 1 week before the surgery,NYHA,cardiopulmonary by-pass time and maximum lactate can provide the individual prediction of AKI for patients undergoing the Cox Maze Ⅲ procedure,which might benefit treatment results for patients and clinicians,as well as postoperative intervention strategy-making.
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