Abstract
Acute kidney injury (AKI) is a common complication of acute illnesses with unfavorable outcomes. This cohort study aimed at constructing prediction models for one-year survival in adult AKI patients based on prognostic nutritional index (PNI), platelet-to-lymphocyte ratio (PLR), neutrophil percentage-to-albumin ratio (NPAR), or neutrophil-to-lymphocyte ratio (NLR), respectively. In total, 6050 patients from Medical Information Mart for Intensive Care III (MIMIC-III) were involved. The least absolute shrinkage and selection operator (LASSO) regression was utilized to screen possible covariates. The samples were randomly divided into the training set and the testing set at a ratio of 7.5 : 2.5, and the prediction models were constructed in the training set by random forest. The prediction values of the models were measured via sensitivity, specificity, negative prediction value (NPV), positive prediction value (PPV), area under the curve (AUC), and accuracy. We found that NLR (OR = 1.261, 95% CI: 1.145-1.388), PLR (OR = 1.295, 95% CI: 1.152-1.445), and NPAR (OR = 1.476, 95% CI: 1.261-1.726) were associated with an increased risk, while PNI (OR = 0.035, 95% CI: 0.020-0.059) was associated with a decreased risk of one-year mortality in AKI patients. The AUC was 0.964 (95% CI: 0.959-0.969) in the training set based on PNI, age, gender, length of stay (LOS) in hospital, platelets (PLT), ethnicity, LOS in ICU, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, glucose, AKI stage, atrial fibrillation (AF), vasopressor, renal replacement therapy (RRT), and mechanical ventilation. The testing set was applied as the internal validation of the model with an AUC of 0.778 (95% CI: 0.754-0.801). In conclusion, PNI accompanied by age, gender, ethnicity, SBP, DBP, heart rate, PLT, glucose, AF, RRT, mechanical ventilation, vasopressor, AKI stage, LOS in ICU, and LOS in hospital exhibited a good predictive value for one-year mortality of AKI patients.