Skip to main content

Advertisement

SpringerLink
Log in

Development and Validation of a Nomogram for Predicting Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Acute kidney injury (AKI) is a common complication after cardiac surgery and associated with adverse outcomes. The purpose of this study is to construct a nomogram to predict the probability of postoperative AKI in pediatric patients undergoing cardiac surgery. We conducted a single-center retrospective cohort study of 1137 children having cardiac surgery under cardiopulmonary bypass. We randomly divided the included patients into development and validation cohorts at a ratio of 7:3. The least absolute shrinkage and selection operator regression model was used for feature selection. We constructed a multivariable logistic regression model to select predictors and develop a nomogram to predict AKI risk. Discrimination, calibration and clinical benefit of the final prediction model were evaluated in the development and validation cohorts. A simple nomogram was developed to predict risk of postoperative AKI using six predictors including age at operation, cyanosis, CPB duration longer than 120 min, cross-clamp time, baseline albumin and baseline creatinine levels. The area under the receiver operator characteristic curve of the nomogram was 0.739 (95% CI 0.693–0.786) and 0.755 (95% CI 0.694–0.816) for the development and validation cohort, respectively. The calibration curve showed a good correlation between predicted and observed risk of postoperative AKI. Decision curve analysis presented great clinical benefit of the nomogram. This novel nomogram for predicting AKI after pediatric cardiac surgery showed good discrimination, calibration and clinical practicability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Neumayr TM, Alge JL, Afonso NS, Akcan-Arikan A (2022) Acute kidney injury after pediatric cardiac surgery. Pediatr Crit Care Med 23(5):e249–e256

    Article  PubMed  Google Scholar 

  2. Tóth R, Breuer T, Cserép Z, Lex D, Fazekas L, Sápi E, Szatmári A, Gál J, Székely A (2012) Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 93(6):1984–1990

    Article  PubMed  Google Scholar 

  3. Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, Jefferies JL (2012) Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 143(2):368–374

    Article  PubMed  Google Scholar 

  4. Taylor ML, Carmona F, Thiagarajan RR, Westgate L, Ferguson MA, del Nido PJ, Rajagopal SK (2013) Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease. J Thorac Cardiovasc Surg 146(1):146–152

    Article  PubMed  Google Scholar 

  5. Morgan CJ, Zappitelli M, Robertson CM, Alton GY, Sauve RS, Joffe AR, Ross DB, Rebeyka IM (2013) Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 162(1):120-127.e121

    Article  PubMed  Google Scholar 

  6. Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, Coca SG, Kim RW, Parikh CR (2011) Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 39(6):1493–1499

    Article  PubMed  PubMed Central  Google Scholar 

  7. Madsen NL, Goldstein SL, Frøslev T, Christiansen CF, Olsen M (2017) Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney Int 92(3):751–756

    Article  PubMed  Google Scholar 

  8. Van den Eynde J, Cloet N, Van Lerberghe R, Sá M, Vlasselaers D, Toelen J, Verbakel JY, Budts W, Gewillig M, Kutty S, Pottel H, Mekahli D (2021) Strategies to prevent acute kidney injury after pediatric cardiac surgery: a network meta-analysis. Clin J Am Soc Nephrol 16(10):1480–1490

    Article  PubMed  PubMed Central  Google Scholar 

  9. Singh SP (2016) Acute kidney injury after pediatric cardiac surgery. Ann Card Anaesth 19(2):306–313

    Article  PubMed  PubMed Central  Google Scholar 

  10. Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A (2017) Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial. Intensive Care Med 43(11):1551–1561

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Yuan SM (2019) Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol 60(1):3–11

    Article  PubMed  Google Scholar 

  12. Cheruku SR, Raphael J, Neyra JA, Fox AA (2023) Acute kidney injury after cardiac surgery: prediction, prevention, and management. Anesthesiology 139(6):880–898

    Article  PubMed  Google Scholar 

  13. Zarbock A, Weiss R, Albert F, Rutledge K, Kellum JA, Bellomo R, Grigoryev E, Candela-Toha AM, Demir ZA, Legros V, Rosenberger P, Galán Menéndez P, Garcia Alvarez M, Peng K, Léger M, Khalel W, Orhan-Sungur M, Meersch M (2023) Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study. Intensive Care Med 49(12):1441–1455

    Article  PubMed  PubMed Central  Google Scholar 

  14. Van den Eynde J, Delpire B, Jacquemyn X, Pardi I, Rotbi H, Gewillig M, Kutty S, Mekahli D (2022) Risk factors for acute kidney injury after pediatric cardiac surgery: a meta-analysis. Pediatr Nephrol 37(3):509–519

    Article  PubMed  Google Scholar 

  15. Lee JH, Jung JY, Park SW, Song IK, Kim EH, Kim HS, Kim JT (2018) Risk factors of acute kidney injury in children after cardiac surgery. Acta Anaesthesiol Scand 62(10):1374–1382

    Article  CAS  PubMed  Google Scholar 

  16. Kourelis G, Kanakis M, Samanidis G, Tzannis K, Bobos D, Kousi T, Apostolopoulou S, Kakava F, Kyriakoulis K, Bounta S, Rammos S, Papagiannis J, Giannopoulos N, Orfanos SE, Dimopoulos G (2022) Acute kidney injury predictors and outcomes after cardiac surgery in children with congenital heart disease: an observational cohort study. Diagnostics (Basel) 12(10):2397

    Article  PubMed  Google Scholar 

  17. Graziani MP, Moser M, Bozzola CM, Gálvez HM, Irman Garrido J, Álvarez PG, Fernie ML (2019) Acute kidney injury in children after cardiac surgery: risk factors and outcomes. A retrospective, cohort study. Arch Argent Pediatr 117(6):e557–e567

    PubMed  Google Scholar 

  18. Pan L, Deng Y, Dai S, Feng X, Feng L, Yang Z, Liao Y, Zheng B (2023) Development and internal validation of a prediction model for acute kidney injury following cardiac valve replacement surgery. Int J Cardiol 370:345–350

    Article  PubMed  Google Scholar 

  19. Zhang Y, Lan Y, Chen T, Chen Q, Guo Z, Jiang N (2022) Prediction of acute kidney injury for acute type A aortic dissection patients who underwent sun’s procedure by a perioperative nomogram. Cardiorenal Med 12(3):117–130

    Article  CAS  PubMed  Google Scholar 

  20. Luo CC, Zhong YL, Qiao ZY, Li CN, Liu YM, Zheng J, Sun LZ, Ge YP, Zhu JM (2022) Development and validation of a nomogram for postoperative severe acute kidney injury in acute type A aortic dissection. J Geriatr Cardiol 19(10):734–742

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Jing H, Liao M, Tang S, Lin S, Ye L, Zhong J, Wang H, Zhou J (2022) Predicting the risk of acute kidney injury after cardiopulmonary bypass: development and assessment of a new predictive nomogram. BMC Anesthesiol 22(1):379

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lin H, Hou J, Tang H, Chen K, Sun H, Zheng Z, Hu S (2020) A novel nomogram to predict perioperative acute kidney injury following isolated coronary artery bypass grafting surgery with impaired left ventricular ejection fraction. BMC Cardiovasc Disord 20(1):517

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Guan C, Li C, Xu L, Zhen L, Zhang Y, Zhao L, Zhou B, Che L, Wang Y, Xu Y (2019) Risk factors of cardiac surgery-associated acute kidney injury: development and validation of a perioperative predictive nomogram. J Nephrol 32(6):937–945

    Article  CAS  PubMed  Google Scholar 

  24. Aoun B, Daher GA, Daou KN, Sanjad S, Tamim H, El Rassi I, Arabi M, Sharara R, Bitar F, Assy J, Bulbul Z, Degheili JA, Majdalani M (2021) Acute kidney injury post-cardiac surgery in infants and children: a single-center experience in a developing country. Front Pediatr 9:637463

    Article  PubMed  PubMed Central  Google Scholar 

  25. Guo S, Bai L, Tong Y, Yu J, Zhang P, Duan X, Liu J (2021) Contrast media exposure in the perioperative period confers no additional risk of acute kidney injury in infants and young children undergoing cardiac surgery with cardiopulmonary bypass. Pediatr Nephrol 36(8):2485–2491

    Article  PubMed  Google Scholar 

  26. Park SK, Hur M, Kim E, Kim WH, Park JB, Kim Y, Yang JH, Jun TG, Kim CS (2016) Risk factors for acute kidney injury after congenital cardiac surgery in infants and children: a retrospective observational study. PLoS ONE 11(11):e0166328

    Article  PubMed  PubMed Central  Google Scholar 

  27. Alten JA, Cooper DS, Blinder JJ, Selewski DT, Tabbutt S, Sasaki J, Gaies MG, Bertrandt RA, Smith AH, Reichle G, Gist KM, Banerjee M, Zhang W, Hock KM, Borasino S (2021) Epidemiology of acute kidney injury after neonatal cardiac surgery: a report from the multicenter Neonatal and Pediatric Heart and Renal Outcomes Network. Crit Care Med 49(10):e941–e951

    Article  CAS  PubMed  Google Scholar 

  28. Greenberg JH, Parsons M, Zappitelli M, Jia Y, Thiessen-Philbrook HR, Devarajan P, Everett AD, Parikh CR (2021) Cardiac biomarkers for risk stratification of acute kidney injury after pediatric cardiac surgery. Ann Thorac Surg 111(1):191–198

    Article  PubMed  Google Scholar 

  29. Fishbein JE, Barone M, Schneider JB, Meyer DB, Hagen J, Bakar A, Grammatikopoulos K, Sethna CB (2022) Blood pressure variability during pediatric cardiac surgery is associated with acute kidney injury. Pediatr Nephrol 37(4):871–879

    Article  PubMed  Google Scholar 

  30. Hayward A, Robertson A, Thiruchelvam T, Broadhead M, Tsang VT, Sebire NJ, Issitt RW (2022) Oxygen delivery in pediatric cardiac surgery and its association with acute kidney injury using machine learning. J Thorac Cardiovasc Surg 165(4):1505–1516

    Article  PubMed  Google Scholar 

  31. Manuel V, Miana LA (2022) New and available biomarker to predict acute kidney injury after pediatric cardiac surgery. Pediatr Nephrol 37(1):223–224

    Article  PubMed  Google Scholar 

  32. Nautiyal A, Sethi SK, Sharma R, Raina R, Tibrewal A, Akole R, Gupta A, Bhan A, Bansal SB (2022) Perioperative albuminuria and clinical model to predict acute kidney injury in paediatric cardiac surgery. Pediatr Nephrol 37(4):881–890

    Article  PubMed  Google Scholar 

  33. Yavuz Y, Isildak FU (2022) Effect of intraoperative theophylline use on acute kidney injury in paediatric cardiac surgery. Cardiol Young 2:1–9

    Google Scholar 

  34. Luo XQ, Kang YX, Duan SB, Yan P, Song GB, Zhang NY, Yang SK, Li JX, Zhang H (2023) Machine learning-based prediction of acute kidney injury following pediatric cardiac surgery: model development and validation study. J Med Internet Res 25:e41142

    Article  PubMed  PubMed Central  Google Scholar 

  35. Zeng X, Shi S, Sun Y, Feng Y, Tan L, Lin R, Li J, Duan H, Shu Q, Li H (2022) A time-aware attention model for prediction of acute kidney injury after pediatric cardiac surgery. J Am Med Inform Assoc 30(1):94–102

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by Chinese Academy of Medical Sciences Central Public Welfare Scientific Research Institute Basal Research Expenses-Clinical and Translational Medicine Research Fund (2021-I2M-C&T-B-036).

Author information

Author notes

  1. Sheng Shi and Chao Xiong have contributed equally to this study.

Authors and Affiliations

  1. Department of Anesthesiology, National Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Sheng Shi, Chao Xiong, Dongyun Bie, Yinan Li & Jianhui Wang

Authors
  1. Sheng Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chao Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dongyun Bie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yinan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jianhui Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SS, CX, and JW conceptualized the study; SS, CX, DB, and YL were responsible for data curation; SS, CX, DB, YL, and JW were responsible for investigation; SS, CX, DB, and YL were responsible for formal analysis; SS, CX, and JW were responsible for methodology; CX and JW were responsible for project administration; CX and JW were responsible for resources; SS, CX, DB, and YL were responsible for software; CX, DB, and YL were responsible for validation; JW was responsible for funding acquisition; CX and JW provided supervision; SS, CX, and JW wrote the original draft; and JW reviewed and edited the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jianhui Wang.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, S., Xiong, C., Bie, D. et al. Development and Validation of a Nomogram for Predicting Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-023-03392-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00246-023-03392-7

Keywords

Search

Navigation