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Age-Specific Prognostic Models for Sepsis-Associated Acute Kidney Injury: A Multicenter Cohort Study
Ju Jin1, Meijuan Xiang1, Jinling Meng1
1Department of Nephrology, The Sixth Afiliated Hospital of Wenzhou Medical University, Lishui People's Hospital, Lishui, Zhejiang, China.
Insights
New age-specific models improve prediction of sepsis-associated acute kidney injury (SA-AKI) mortality. These models, tailored for different age groups, offer better risk assessment than general scores for SA-AKI patients.
Area of Science:
- Critical Care Medicine
- Nephrology
- Epidemiology
Background:
- Sepsis-associated acute kidney injury (SA-AKI) has varied outcomes across age groups.
- Current prognostic tools for SA-AKI often overlook age-related pathophysiological differences.
- Real-world data highlights the need for age-specific SA-AKI risk prediction.
Purpose of the Study:
- To develop and validate age-specific prognostic models for SA-AKI.
- To compare the performance of age-specific models against conventional severity scores.
- To identify key predictors for SA-AKI mortality in different age cohorts.
Main Methods:
- Analysis of 3662 SA-AKI patients from MIMIC-IV and eICU databases.
- Stratification into three age cohorts: under 65, 65-80, and over 80 years.
- Development and performance evaluation (AUC, sensitivity, specificity) of clinical prediction models for each cohort.
Main Results:
- Age-specific models outperformed conventional severity scores in SA-AKI mortality prediction.
- Optimal models included factors like urinary infection, lactate, and vasopressor use, varying by age group.
- AUC values ranged from 0.753 to 0.770, with high sensitivity and specificity across cohorts.
- Survival analysis confirmed significant mortality risk stratification by age.
Conclusions:
- Age-specific prognostic models significantly enhance SA-AKI mortality prediction.
- These models incorporate clinically modifiable factors for personalized risk assessment.
- Tailored treatment strategies for SA-AKI may benefit from these age-specific insights.
Abstract:
BACKGROUND Sepsis-associated acute kidney injury (SA-AKI) exhibits distinct clinical outcomes across age groups, yet current prognostic methods seldom consider age-related pathophysiologic differences. This multicenter study explored age-specific prognostic models for patients with SA-AKI using real-world critical care data. MATERIAL AND METHODS We analyzed 3662 patients with SA-AKI from the MIMIC-IV and eICU databases, stratified into 3 age cohorts: under 65, 65-80, and over 80. For each cohort, we constructed clinical prediction models. Model performance was evaluated using receiver operating characteristic curve analysis, along with sensitivity and specificity at optimal thresholds. RESULTS Age-specific clinical models demonstrated superior predictive performance compared with conventional severity scores. For patients younger than 65 years, the optimal model - incorporating urinary infection, catheter-related infection, lactate, and norepinephrine use - achieved an area under the curve (AUC) of 0.753 (95% confidence intervals [CI], 0.721-0.785) with 67.0% sensitivity and 73.1% specificity. In the 65-80-year cohort, the optimal model - incorporating urinary infection, blood urea nitrogen, lactate, and vasopressor use - achieved an AUC of 0.769 (95% CI, 0.743-0.796) with 78.2% sensitivity. For patients older than 80 years, the optimal model - incorporating urinary infection, catheter-related infection, lactate, vasopressor use, and intensive care unit length of stay - achieved an AUC of 0.770 (95% CI, 0.737-0.803) with 79.7% sensitivity. Survival curves confirmed significant mortality risk stratification across all age groups. CONCLUSIONS Age-specific prognostic models incorporating clinically modifiable factors substantially improved mortality prediction in SA-AKI compared with conventional severity scores. These models facilitate personalized risk assessment and may guide age-tailored treatments for this high-risk population.
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