Construction and Evaluation of a Nomogram for Unplanned Readmission Within 1 Year After Kidney Transplantation: Based...

To develop and evaluate a risk prediction model for unplanned readmission within 1 year following kidney transplantation using Lasso-logistic regression.

Clinical data of kidney transplant recipients from the Department of Organ Transplantation at the Affiliated Hospital of Guizhou Medical University, spanning April 2017 to June 2023, were retrospectively analyzed. Initially, Lasso regression analysis was used to select predictive variables. Subsequently, logistic regression analysis was employed to construct a risk prediction model, which was presented as a nomogram. Bootstrap repeated sampling was conducted 1000 times for internal model validation. The comprehensive efficacy of the prediction model was assessed from four dimensions: discrimination, fit, calibration, and clinical benefit.

The incidence of unplanned readmission within 1-year post-transplant was 36.48%. Serum creatinine, cystatin C, albumin, serum potassium, serum magnesium, drinking history, rejection, and length of stay were the predictors of unplanned readmission within 1 year after renal transplantation. The comprehensive ability of the risk prediction model for unplanned readmission within 1 year after renal transplantation was as follows: The area under the receiver operating characteristic curve of the nomogram model was 0.715 (95% CI: 0.673-0.757). The internal validation results showed that the corrected C-index was 0.700. The positive predictive value of the model was 0.533 and the negative predictive value was 0.785. The Hosmer-Lemeshow goodness of fit test result was χ² = 4.941, P = 0.764, indicating a satisfactory fit of the model. In the calibration curve, the actual fitting curve was well-fitted to the standard curve, and the model calibration ability was acceptable. The clinical decision curve confirmed the clinical value of the model and its positive impact on actual decision-making.

The constructed model demonstrates considerable predictive value for unplanned readmission within 1 year after kidney transplantation. It serves as a valuable tool for early clinical warning, enabling healthcare professionals to formulate personalized preventive strategies based on identified risk factors.