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已发表论文
基于血清尿酸与白蛋白比值预测心脏瓣膜手术后急性肾损伤的列线图的开发及内部验证
Authors Zhao X , Wang J, Bai W, Zhang W, Huang C, Qin Z, Wei K, Han M , Yan L, Gu Y, Shao F
Received 4 September 2025
Accepted for publication 24 November 2025
Published 28 November 2025 Volume 2025:18 Pages 16747—16760
DOI https://doi.org/10.2147/JIR.S563670
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Wenjian Li
Xiaoru Zhao,1,* Juntao Wang,2,* Wenxin Bai,1 Wenwen Zhang,1 Chunling Huang,1 Zengyuan Qin,1 Kaiyue Wei,1 Minghui Han,1,3 Lei Yan,1,3 Yue Gu,1,3 Fengmin Shao1,3
1Department of Nephrology, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China; 2Department of Nephrology, The First People’s Hospital of Shangqiu, Shangqiu, Henan, People’s Republic of China; 3Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Fengmin Shao; Yue Gu, Email fengminshao@126.com; guyuesunny@zzu.edu.cn
Background: The serum Uric Acid-to-Albumin Ratio (sUAR) is a novel inflammatory indicator. We aimed to construct and validate a prediction model for acute kidney injury (AKI) following cardiac valve surgery (CVS) based on the preoperative sUAR.
Methods: We retrospectively collected clinical data from adult patients undergoing CVS with cardiopulmonary bypass at the Heart Center of Henan Provincial People’s Hospital between December 2020 to December 2021. The primary outcome was postoperative AKI, defined according to the KDIGO creatinine criteria. Patients were categorized as either AKI or non-AKI based on this outcome. Multivariate logistic regression to identify independent risk factors. A nomogram model was developed. The receiver operating characteristic (ROC) curve assessed discrimination. The calibration curve and Hosmer-Lemeshow test evaluated calibration. Clinical practicability was assessed through decision curve analysis (DCA) and clinical impact curve (CIC). The Bootstrap method was used for internal verification.
Results: A total of 440 patients were enrolled, and the incidence of AKI was 33.4%. Multivariate analysis revealed that sUAR (per μmol/g, OR=1.467, 95% CI 1.311– 1.642, P< 0.001), age (per 10 years, OR=1.612, 95% CI 1.261– 2.062, P< 0.001), atrial fibrillation (OR=2.485, 95% CI 1.573– 3.924, P< 0.001), hemoglobin (per g/L, OR=0.985, 95% CI 0.973– 0.998, P=0.025) were the independent risk factors. The nomogram based on sUAR achieved an area under the curve (AUC) of 0.779 (95% CI 0.734– 0.824, P< 0.001) for predicting AKI. The average AUC after internal validation of the nomogram model was 0.776 (95% CI 0.767– 0.779). The calibration curve and Hosmer-Lemeshow test indicated that the predicted and observed results agreed well, while the DCA and CIC curves demonstrated favorable clinical applicability within a specific threshold range.
Conclusion: The prediction model incorporating sUAR provides reliable discrimination and clinical utility for assessing AKI risk following CVS.
Keywords: acute kidney injury, prediction model, cardiac valve surgery, serum uric acid-to-albumin ratio, nomogram
1Department of Nephrology, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China; 2Department of Nephrology, The First People’s Hospital of Shangqiu, Shangqiu, Henan, People’s Republic of China; 3Henan Provincial Clinical Research Center for Kidney Disease, Henan Provincial Key Laboratory of Kidney Disease and Immunology, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Fengmin Shao; Yue Gu, Email fengminshao@126.com; guyuesunny@zzu.edu.cn
Background: The serum Uric Acid-to-Albumin Ratio (sUAR) is a novel inflammatory indicator. We aimed to construct and validate a prediction model for acute kidney injury (AKI) following cardiac valve surgery (CVS) based on the preoperative sUAR.
Methods: We retrospectively collected clinical data from adult patients undergoing CVS with cardiopulmonary bypass at the Heart Center of Henan Provincial People’s Hospital between December 2020 to December 2021. The primary outcome was postoperative AKI, defined according to the KDIGO creatinine criteria. Patients were categorized as either AKI or non-AKI based on this outcome. Multivariate logistic regression to identify independent risk factors. A nomogram model was developed. The receiver operating characteristic (ROC) curve assessed discrimination. The calibration curve and Hosmer-Lemeshow test evaluated calibration. Clinical practicability was assessed through decision curve analysis (DCA) and clinical impact curve (CIC). The Bootstrap method was used for internal verification.
Results: A total of 440 patients were enrolled, and the incidence of AKI was 33.4%. Multivariate analysis revealed that sUAR (per μmol/g, OR=1.467, 95% CI 1.311– 1.642, P< 0.001), age (per 10 years, OR=1.612, 95% CI 1.261– 2.062, P< 0.001), atrial fibrillation (OR=2.485, 95% CI 1.573– 3.924, P< 0.001), hemoglobin (per g/L, OR=0.985, 95% CI 0.973– 0.998, P=0.025) were the independent risk factors. The nomogram based on sUAR achieved an area under the curve (AUC) of 0.779 (95% CI 0.734– 0.824, P< 0.001) for predicting AKI. The average AUC after internal validation of the nomogram model was 0.776 (95% CI 0.767– 0.779). The calibration curve and Hosmer-Lemeshow test indicated that the predicted and observed results agreed well, while the DCA and CIC curves demonstrated favorable clinical applicability within a specific threshold range.
Conclusion: The prediction model incorporating sUAR provides reliable discrimination and clinical utility for assessing AKI risk following CVS.
Keywords: acute kidney injury, prediction model, cardiac valve surgery, serum uric acid-to-albumin ratio, nomogram