Derivation and external validation of a simple risk score for predicting severe acute kidney injury after intravenous cisplatin: Cohort study Journal Article
| Authors: | Gupta, S.; Glezerman, I. G.; Hirsch, J. S.; Chen, K. L.; Devaraj, N.; Wells, S. L.; Seitter, R. H.; Kaunfer, S. A.; Jose, A. M.; Rao, S. P.; Ortega, J. L.; Green-Lingren, O.; Hayden, R.; Bendapudi, P. K.; Chute, D. F.; Sise, M. E.; Jhaveri, K.; Page, V.; Abramson, M. H.; Motwani, S. S.; Xu, W. X.; Sehgal, K.; Reynolds, K. L.; Bansal, A.; Abudayyeh, A.; Leaf, D. E. |
| Article Title: | Derivation and external validation of a simple risk score for predicting severe acute kidney injury after intravenous cisplatin: Cohort study |
| Abstract: | OBJECTIVE To develop and externally validate a prediction model for severe cisplatin associated acute kidney injury (CP-AKI). DESIGN Multicenter cohort study. SETTING Six geographically diverse major academic cancer centers across the US. PARTICIPANTS Adults (>= 18 years) receiving their first dose of intravenous cisplatin, 2006-22. MAIN OUTCOME MEASURES 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. RESULTS A total of 24 717 adults were included, with 11 766 in the derivation cohort (median age 59 (interquartile range (IQR) 50-67)) and 12 951 in the validation cohort (median age 60 (IQR 50-67)). The incidence of CP-AKI was 5.2% (608/11 766) in the derivation cohort and 3.3% (421/12 951) 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). CONCLUSION 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. |
| Keywords: | chemotherapy; carcinoma; impact; phase-ii; eligibility; acute-renal-failure; critically-ill patients; cancer; prognosis; magnesium protects |
| Journal Title: | BMJ: British Medical Journal (International Edition) |
| Volume: | 384 |
| ISSN: | 0959-8146 |
| Publisher: | BMJ Publishing Group Ltd. |
| Date Published: | 2024-01-01 |
| Start Page: | e077169 |
| Language: | English |
| ACCESSION: | WOS:001196000600015 |
| DOI: | 10.1136/bmj-2023-077169 |
| PROVIDER: | wos |
| PMCID: | PMC10964715 |
| PUBMED: | 38538012 |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF -- Source: Wos |
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