Risk factors and nomogram prediction model for prognosis in sepsis with acute kidney injury.

BACKGROUND

Sepsis-associated acute kidney injury (AKI) is a frequent and life-threatening complication in critically ill patients, yet early risk stratification remains challenging. This study aimed to identify independent prognostic factors and to develop and internally validate a nomogram for predicting 28-day mortality in patients with sepsis-associated AKI.

METHODS

In this retrospective study, 238 adult patients with sepsis defined by Sepsis-3 criteria and AKI defined according to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines were enrolled between January 2021 and December 2024. Clinical and immunologic variables obtained within 24 h of intensive care unit (ICU) admission were analyzed. Multivariable logistic regression was performed to identify independent predictors of 28-day mortality. Model performance was assessed using receiver operating characteristic (ROC) analysis, calibration plots, bootstrap validation, and decision curve analysis (DCA).

RESULTS

Among the 238 enrolled patients, 91 were classified as non-survivors and 147 as survivors. Multivariable analysis identified AKI stage 2 (odds ratio [OR] 3.857, 95% confidence interval [CI] 2.101-7.082), AKI stage 3 (OR 5.585, 95% CI 2.652-11.761), ICU stay (OR 1.802, 95% CI 1.304-2.490), T helper 17 cells (OR 2.881, 95% CI 1.257-6.600), interleukin-17 (OR 1.226, 95% CI 1.073-1.401), and 24-hour fluid balance (OR 1.241 per 100 mL/day, P < 0.001) as independent predictors of poor prognosis. The nomogram showed good discrimination, with an area under the curve of 0.859 and a bootstrap-corrected concordance index of 0.844. Calibration and DCA demonstrated adequate model fit and clinical utility.

CONCLUSIONS

AKI severity, early fluid accumulation, ICU course, and immune-inflammatory activation are independently associated with 28-day mortality in sepsis-associated AKI. The proposed nomogram provides individualized risk estimation and may assist in early prognostic stratification.

CLINICAL TRIAL NUMBER: Not applicable.