ArticleFrontiers in nephrology2026
A four-parameter laboratory risk stratification model at admission for 90-day mortality in hepatorenal syndrome-acute kidney injury: a single-center derivation and internal validation study.
Article in Frontiers in nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a high-mortality complication of advanced cirrhosis. Early risk stratification after hospital admission may support clinical assessment and research on escalation pathways, but simple admission-based models that avoid in-hospital data leakage remain limited. Methods: We performed a retrospective single-center derivation and internal-validation study of hospitalized adults with chart-review-confirmed HRS-AKI according to contemporary ADQI/ICA criteria. Candidate predictors were restricted Results: The final analysis included 77 patients. The final predictor set comprised INR, albumin, ln(total bilirubin), and ln(C-reactive protein). For 90-day mortality, the final four-laboratory model showed an apparent AUC of 0.781 (95% CI, 0.715-0.926) and an optimism-corrected AUC of 0.758 (95% CI, 0.648-0.859), with an apparent Brier score of 0.144 (95% CI, 0.081-0.176), an optimism-corrected Brier score of 0.168 (95% CI, 0.117-0.212), an optimism-corrected calibration slope of 0.770, and an optimism-corrected calibration-in-the-large/intercept of 0.168. Performance for in-hospital hemodialysis and ICU admission was limited, with optimism-corrected AUCs of 0.580 (95% CI, 0.451-0.733) and 0.631 (95% CI, 0.514-0.737), respectively. MELD-family benchmarks showed numerically lower within-cohort discrimination than the four-laboratory model; these comparisons were descriptive and hypothesis-generating. Conclusions: In this single-center derivation and internal-validation study, an admission-based four-laboratory model showed moderate internally validated discrimination for 90-day mortality in hospitalized patients with HRS-AKI. The model should be interpreted as a preliminary risk-stratification approach requiring external validation and, if necessary, recalibration before clinical use. Secondary endpoint models for hemodialysis and ICU admission are exploratory and should not be used for threshold-based decision-making.
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