Development and validation of a dynamic nomogram for acute kidney injury prediction in ICU patients with acute heart failure.

Objective: Developing and validating a simple and clinically useful dynamic nomogram for predicting early acute kidney injury (AKI) in patients with acute heart failure (AHF) admitted to the intensive care unit (ICU). Methods: Clinical data from patients with AHF were obtained from the Medical Information Mart for Intensive Care IV database. The patients with AHF were randomly allocated into derivation and validation sets. The independent predictors for AKI development in AHF patients were identified through least absolute shrinkage and selection operator and multivariate logistic regression analyses. A nomogram was developed based on the results of the multivariable logistic regression to predict early AKI onset in AHF patients, which was subsequently implemented as a web-based calculator for clinical application. An evaluation of the nomogram was conducted using discrimination, calibration curves, and decision curve analyses (DCA). Results: After strict screening, 1,338 patients with AHF were included in the derivation set, and 3,129 in the validation set. Sepsis, use of human albumin, age, mechanical ventilation, aminoglycoside administration, and serum creatinine levels were identified as predictive factors for AKI in patients with AHF. The discrimination of the nomogram in both the derivation and validation sets was 0.81 (95% confidence interval: 0.78-0.83) and 0.79 (95% confidence interval: 0.76-0.83). Additionally, the calibration curve demonstrated that the predicted outcomes aligned well with the actual observations. Ultimately, the DCA curves indicated that the nomogram exhibited favorable clinical applicability. Conclusion: The nomogram that integrates clinical risk factors and enables the personalized prediction of AKI in patients with AHF upon admission to the ICU, which has the potential to assist in identifying AHF patients who would derive the greatest benefit from interventions aimed at preventing and treating AKI.