{"id":25816,"date":"2024-06-01T04:45:00","date_gmt":"2024-05-31T20:45:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25816"},"modified":"2024-06-01T06:11:17","modified_gmt":"2024-05-31T22:11:17","slug":"bmj%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%a2%84%e6%b5%8b%e9%9d%99%e8%84%89%e6%b3%a8%e5%b0%84%e9%a1%ba%e9%93%82%e5%90%8e%e4%b8%a5%e9%87%8d%e6%80%a5%e6%80%a7%e8%82%be%e6%8d%9f%e4%bc%a4","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25816","title":{"rendered":"[BMJ\u53d1\u8868\u8bba\u6587]\uff1a\u9884\u6d4b\u9759\u8109\u6ce8\u5c04\u987a\u94c2\u540e\u4e25\u91cd\u6025\u6027\u80be\u635f\u4f24\u7684\u7b80\u5355\u98ce\u9669\u8bc4\u5206\u7684\u5efa\u7acb\u4e0e\u5916\u90e8\u9a8c\u8bc1"},"content":{"rendered":"\n

Research<\/strong><\/p>\n\n\n\n

Derivation and external validation of a simple risk score for predicting severe acute kidney injury after intravenous cisplatin: cohort study<\/h1>\n\n\n\n

Shruti Gupta<\/a>, Ilya G Glezerman, Jamie S Hirsch<\/a>,\u00a0et al<\/h3>\n\n\n\n

BMJ<\/em>\u00a02024;\u00a0384\u00a0doi:\u00a0https:\/\/doi.org\/10.1136\/bmj-2023-077169<\/a>\u00a0(Published 27 March 2024)Cite this as:\u00a0BMJ<\/em>\u00a02024;384:e077169<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Objective<\/strong> To develop and externally validate a prediction model for severe cisplatin associated acute kidney injury (CP-AKI).<\/p>\n\n\n\n

Design<\/strong> Multicenter cohort study.<\/p>\n\n\n\n

Setting<\/strong> Six geographically diverse major academic cancer centers across the US.<\/p>\n\n\n\n

Participants<\/strong> Adults (\u226518 years) receiving their first dose of intravenous cisplatin, 2006-22.<\/p>\n\n\n\n

Main outcome measures<\/strong> The primary outcome was CP-AKI, defined as a twofold or greater increase in serum creatinine or kidney replacement therapy within 14 days of a first dose of intravenous cisplatin. Independent predictors of CP-AKI were identified using a multivariable logistic regression model, which was developed in a derivation cohort and tested in an external validation cohort. For the primary model, continuous variables were examined using restricted cubic splines. A simple risk model was also generated by converting the odds ratios from the primary model into risk points. Finally, a multivariable Cox model was used to examine the association between severity of CP-AKI and 90 day survival.<\/p>\n\n\n\n

Results<\/strong>\u00a0A total of 24\u2009717 adults were included, with 11\u2009766 in the derivation cohort (median age 59 (interquartile range (IQR) 50-67)) and 12\u2009951 in the validation cohort (median age 60 (IQR 50-67)). The incidence of CP-AKI was 5.2% (608\/11\u2009766) in the derivation cohort and 3.3% (421\/12\u2009951) in the validation cohort. Each of the following factors were independently associated with CP-AKI in the derivation cohort: age, hypertension, diabetes mellitus, serum creatinine level, hemoglobin level, white blood cell count, platelet count, serum albumin level, serum magnesium level, and cisplatin dose. A simple risk score consisting of nine covariates was shown to predict a higher risk of CP-AKI in a monotonic fashion in both the derivation cohort and the validation cohort. Compared with patients in the lowest risk category, those in the highest risk category showed a 24.00-fold (95% confidence interval (CI) 13.49-fold to 42.78-fold) higher odds of CP-AKI in the derivation cohort and a 17.87-fold (10.56-fold to 29.60-fold) higher odds in the validation cohort. The primary model had a C statistic of 0.75 and showed better discrimination for CP-AKI than previously published models, the C statistics for which ranged from 0.60 to 0.68 (DeLong P<0.001 for each comparison). Greater severity of CP-AKI was monotonically associated with shorter 90 day survival (adjusted hazard ratio 4.63 (95% CI 3.56 to 6.02) for stage 3 CP-AKI versus no CP-AKI).<\/p>\n\n\n\n

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Conclusion<\/strong> This study found that a simple risk score based on readily available variables from patients receiving intravenous cisplatin could predict the risk of severe CP-AKI, the occurrence of which is strongly associated with death.<\/p>\n","protected":false},"excerpt":{"rendered":"

Research Derivation and external validation of a simple […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25816"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25816"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25816\/revisions"}],"predecessor-version":[{"id":25817,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25816\/revisions\/25817"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25816"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25816"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25816"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}