A nomogram-based prediction model accurately predicted acute kidney injury following modified Morrow myectomy in patients with hypertrophic obstructive cardiomyopathy with an AUC of 0.904.
Cohort (n=270)
No
What are the incidence and risk factors for acute kidney injury in patients with hypertrophic obstructive cardiomyopathy undergoing modified Morrow septal myectomy?
A nomogram incorporating preoperative creatinine, postoperative ALT, total bilirubin, pulmonary infection, and red blood cell transfusion accurately predicts the risk of acute kidney injury following modified Morrow myectomy in HOCM patients.
Effect estimate: AUC 0.904 (95% CI 0.862-0.936)
p-value: p=<0.0001
OBJECTIVE: This study explored the incidence and risk factors of acute kidney injury (AKI) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing modified Morrow septal myectomy and developed a risk prediction model to optimize perioperative management. METHODS: A retrospective cohort of HOCM patients who underwent modified Morrow procedure between 2012 and 2024 was analyzed. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and patients were grouped into AKI and non-AKI cohorts. Univariate analysis followed by binary logistic regression identified independent predictors of AKI, which informed the development of a nomogram-based prediction model. Model performance was assessed using the concordance index (C-index), calibration curves, and decision curve analysis. RESULTS: Among 270 patients, 54 (20%) developed AKI, including 24, 12, and 18 patients classified as stage 1, stage 2, and stage 3 respectively, with 15 requiring hemodialysis. Independent predictors included preoperative creatinine (OR = 1.069, P < 0.001), postoperative 48-h alanine aminotransferase (ALT) (OR = 1.001, P = 0.021), total bilirubin (TBIL) (OR = 1.036, P = 0.015), pulmonary infection (OR = 9.432, P < 0.001), and red blood cell transfusion (OR = 1.246, P = 0.002). The logistic model achieved 81.13% sensitivity, 87.91% specificity, and an AUC of 0.904 (95% CI: 0.862 ~ 0.936). The nomogram showed excellent accuracy, with a C-index of 0.890. CONCLUSION: AKI is a frequent and severe complication after modified Morrow myectomy in HOCM. Identifying high-risk patients and addressing modifiable factors may improve perioperative management and outcomes.
Zeng et al. (Sat,) conducted a cohort in Hypertrophic obstructive cardiomyopathy (HOCM) (n=270). Modified Morrow septal myectomy was evaluated on Acute kidney injury (AKI) prediction model accuracy (AUC) (AUC 0.904, 95% CI 0.862-0.936, p=<0.0001). A nomogram-based prediction model accurately predicted acute kidney injury following modified Morrow myectomy in patients with hypertrophic obstructive cardiomyopathy with an AUC of 0.904.