To identify risk factors of acute kidney injury (AKI) after intracerebral hemorrhage surgery and establish a predictive model for predicting postoperative AKI in these patients.

Clinical data of 207 patients admitted to the ICU between October 2014 and October 2021 were retrospectively collected, and patients were divided into AKI (35 cases) and non-AKI (172 cases) based on diagnosis of postoperative AKI. Baseline data of patients in 2 groups (gender, age, height, body quality, basic diseases), preoperative status assessment [Glasgow coma scale (GCS) score, preoperative laboratory results, American Association of Anesthesiologists (ASA) classification], intraoperative (blood volume loss) and during ICU [heart rate (HR), blood pressure, body temperature, acute physiology and chronic health status evaluation (APACHE Ⅱ) score, laboratory results, treatment and medication] were recorded. Independent risk factors were identified by Lasso-Logistic regression analysis and a nomogram was established. Calibration and predictive analysis were established to evaluate the nomogram. The predictive ability of the model was evaluated with receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (H-L) test.

Preoperative evaluation showed that GCS score in the AKI group was significantly lower than the non-AKI group (Z=4.225, P<0.001), and the proportion of patients with ASA grade over 3 was significantly higher than that in non-AKI group (χ²=17.988, P<0.001), which were statistically significant. Postoperative conditions showed that, the HR and APACHEⅡ scores in AKI patients were significantly higher than those in non-AKI patients, and the differences were statistically significant (Z=2.730, P=0.006; Z=4.743, P<0.001); the proportion postoperative vasoactive treatment in AKI patients was significantly higher (χ²=6.571, P=0.010). Among 207 patients, a total of 27 patients died in hospital, and the overall fatality rate was 13.04%, which is significantly higher in AKI group (χ²=36.249, P<0.001);length of mechanical ventilation and length of ICU stay were significantly higher (Z=3.317, P=0.001; Z=3.271, P=0.001) in AKI patients. Lasso-Logistic regression analysis indicates preoperative GCS score (OR=0.89, 95%CI: 0.80-0.99, P=0.031), ASA grade (OR=2.87, 95%CI: 1.12-7.39, P=0.029), heart rate (OR=1.02, 95%CI: 1.00-1.04, P=0.016) were identified as independent risk factors. A nomogram was established using these three factors. The nomogram showed a robust prediction, with an area under the receiver operating characteristic curve (AUC) of 0.795 (95%CI: 0.727-0.863), H-L test was P=0.376.

Preoperative GCS score, ASA grade and heart rate when admitting to ICU are independent risk factors of AKI development after intracerebral hemorrhage surgery. The Nomogram established using these three factors can be a valuable and convenient tool to predict high risk patients for AKI and may improve their prognosis.