DEVELOPMENT OF PREDICTIVE MODEL FOR 30-DAY MORTALITY IN CANCER PATIENTS WITH AKI REQUIRING RRT IN ICU: A SINGLE-CENTRE RETROSPECTIVE COHORT STUDY

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Abstract Title *

DEVELOPMENT OF PREDICTIVE MODEL FOR 30-DAY MORTALITY IN CANCER PATIENTS WITH AKI REQUIRING RRT IN ICU: A SINGLE-CENTRE RETROSPECTIVE COHORT STUDY

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Co-author 1

Pratya Pumuthaivirat pratya.pum@cra.ac.th Chulabhorn Royal Acadamy Division of Nephrology, Department of Internal Medicine, Chulabhorn hospital Bangkok Thailand -

Co-author 2

Tanatorn Siripoon Tanatorn.siripoon@gmail.com Chulabhorn Royal Academy Department of Medicine, Chulabhorn Hospital Bangkok Thailand *

Co-author 3

Patthraphorn Chalermsuk Patthraphorn.cha@cra.ac.th Chulabhorn Royal Academy Department of Medicine, Chulabhorn Hospital Bangkok Thailand -

Co-author 4

Prasittiporn Tangjitaree Prasittiporn.tan@cra.ac.th Chulabhorn Royal Acadamy Division of Critical Care Medicine, Department of Internal Medicine, Chulabhorn hospital Bangkok Thailand -

Co-author 5

Suppalux Limpiwattakee Suppalux.lim@cra.ac.th Chulabhorn Royal Acadamy Department of Medicine, Chulabhorn Hospital Bangkok Thailand -

Co-author 6

Kritrawin Saranyanurak Kritrawin.sar@cra.ac.th Chulabhorn Royal Acadamy Department of Medicine, Chulabhorn Hospital Bangkok Thailand -

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

More than half of cancer patients admitted to the intensive care unit (ICU) develop acute kidney injury (AKI) and frequently need renal replacement therapy (RRT). The mortality rate of these patients is higher than non-cancer patients. However, only few studies have been performed to evaluate the outcomes of RRT in critically ill cancer patients, and its benefits are still debated. This study aimed to develop practical predictive tools to estimate 30-day mortality in cancer patients with AKI who required RRT in the ICU.

Methods

A retrospective cohort study was conducted at a university hospital with cancer centre in Bangkok, Thailand. We reviewed the medical records from January 2016 to June 2025, and the data were collected to identify predictive factors of 30-day mortality after RRT. Potential predictors of poor outcomes were analyzed, and logistic regression was used to construct predictive model.

Results

The study included a total of 115 patients with a mean (SD) age of 65 (14.5) years. 78 patients (67.8%) had solid tumors. Continuous RRT was performed in 62 patients (53.9%). The 30-day and 90-day mortality rates were 69.6% and 81.7%, respectively. According to the multivariable logistic regression model, the predictive model based on four predictors (metastasis solid malignancy or high-grade hematological malignancy, impaired performance status, Quick Sequential Organ Failure(qSOFA) score, serum albumin level) show excellent predictive performance, as indicated by a C-index of 0.914 (95%CI [0.8488, 0.9792]) in the development cohort.

Table 1 Predictive factors of 30-day mortality after RRT, odds ratio (OR), 95% confidence interval (CI), logistic regression beta coefficient, and assigned item score

Table 2 Distribution of 30-day mortality into low and high probability categories, likelihood ratio of positive (LHR+), Sensitivity, Specificity and 95% confidence interval (CI)

Figure 1 Receiver Operating Characteristic curves and Areas Under the Curve to predict 30-day mortality after RRT

Conclusion

Cancer patients with AKI requiring RRT in the ICU have a high risk of 30-day and 90-day mortality. A four-variable model using type of cancer, performance status, qSOFA score, and serum albumin level showed excellent discrimination for 30-day mortality and may assist risk stratification and clinical decision-making in this population.

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