{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:08:32Z","timestamp":1784268512955,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100022804","name":"Eva Mayr-Stihl Stiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022804","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nephrol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a high-mortality complication of advanced cirrhosis. Early risk stratification after hospital admission may support clinical assessment and research on escalation pathways, but simple admission-based models that avoid in-hospital data leakage remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We performed a retrospective single-center derivation and internal-validation study of hospitalized adults with chart-review-confirmed HRS-AKI according to contemporary ADQI\/ICA criteria. Candidate predictors were restricted\n                      <jats:italic>a priori<\/jats:italic>\n                      to admission laboratory values to minimize data leakage. Admission variables were prioritized using random-forest importance rankings under prespecified parsimony constraints, followed by endpoint-specific closed-form logistic regression models using an identical four-predictor set across outcomes. The primary endpoint was 90-day all-cause mortality. In-hospital hemodialysis and ICU admission were prespecified secondary endpoints and are reported as exploratory. Internal validation used bootstrap resampling with assessment of apparent and optimism-corrected discrimination and overall accuracy; calibration slope and calibration-in-the-large\/intercept were reported descriptively. For contextual benchmarking, admission MELD, MELD-Na, and MELD 3.0 were evaluated as single-predictor logistic benchmark models for 90-day mortality within the same cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final analysis included 77 patients. The final predictor set comprised INR, albumin, ln(total bilirubin), and ln(C-reactive protein). For 90-day mortality, the final four-laboratory model showed an apparent AUC of 0.781 (95% CI, 0.715-0.926) and an optimism-corrected AUC of 0.758 (95% CI, 0.648-0.859), with an apparent Brier score of 0.144 (95% CI, 0.081-0.176), an optimism-corrected Brier score of 0.168 (95% CI, 0.117-0.212), an optimism-corrected calibration slope of 0.770, and an optimism-corrected calibration-in-the-large\/intercept of 0.168. Performance for in-hospital hemodialysis and ICU admission was limited, with optimism-corrected AUCs of 0.580 (95% CI, 0.451-0.733) and 0.631 (95% CI, 0.514-0.737), respectively. MELD-family benchmarks showed numerically lower within-cohort discrimination than the four-laboratory model; these comparisons were descriptive and hypothesis-generating.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this single-center derivation and internal-validation study, an admission-based four-laboratory model showed moderate internally validated discrimination for 90-day mortality in hospitalized patients with HRS-AKI. The model should be interpreted as a preliminary risk-stratification approach requiring external validation and, if necessary, recalibration before clinical use. Secondary endpoint models for hemodialysis and ICU admission are exploratory and should not be used for threshold-based decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneph.2026.1796660","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:43:30Z","timestamp":1784267010000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A four-parameter laboratory risk stratification model at admission for 90-day mortality in hepatorenal syndrome-acute kidney injury: a single-center derivation and internal validation study"],"prefix":"10.3389","volume":"6","author":[{"given":"Julian","family":"M\u00fcller-K\u00fchnle","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine and Nephrology, Robert Bosch Krankenhaus (Robert Bosch Hospital)","place":["Stuttgart, Germany"]},{"name":"Paracelsus Medizinische Universit\u00e4t (Paracelsus Medical University)","place":["Salzburg, Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Robert Bosch Krankenhaus (Robert Bosch Hospital)","place":["Stuttgart, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Severin","family":"Schricker","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine and Nephrology, Robert Bosch Krankenhaus (Robert Bosch Hospital)","place":["Stuttgart, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Zoller","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectious Diseases, and Pulmonology, Klinikum Stuttgart (Stuttgart Hospital)","place":["Stuttgart, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Latus","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine and Nephrology, Robert Bosch Krankenhaus (Robert Bosch Hospital)","place":["Stuttgart, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Schanz","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine and Nephrology, Robert Bosch Krankenhaus (Robert Bosch Hospital)","place":["Stuttgart, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1038\/s41572-018-0022-7","article-title":"Hepatorenal syndrome","volume":"4","author":"Gin\u00e8s","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.07.002","article-title":"News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document","volume":"71","author":"Angeli","year":"2019","journal-title":"J Hepatol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31884","article-title":"Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American Association for the Study of Liver Diseases","volume":"74","author":"Biggins","year":"2021","journal-title":"Hepatology"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.03.031","article-title":"Acute kidney injury in patients with cirrhosis: Acute Disease Quality Initiative (ADQI) and International Club of Ascites (ICA) joint multidisciplinary consensus meeting","volume":"81","author":"Nadim","year":"2024","journal-title":"J Hepatol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800600817","article-title":"Transection of the oesophagus for bleeding oesophageal varices","volume":"60","author":"Pugh","year":"1973","journal-title":"Br J Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/s0016-5085(01)80377-2","article-title":"A model to predict survival in patients with end-stage liver disease","volume":"33","author":"Kamath","year":"2001","journal-title":"Hepatology"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.06.012","article-title":"Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure","volume":"61","author":"Jalan","year":"2014","journal-title":"J Hepatol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.2196\/10969","article-title":"Data leakage in health outcomes prediction with machine learning. 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