Association between D-dimer and in-hospital mortality risk in Acute Kidney Injury based on latent class dynamic trajectory
ObjectivesTo investigate the longitudinal D-dimer trajectories in hospitalized acute kidney injury (AKI) patients and analyze their association with in-hospital mortality risk.MethodsA retrospective study was conducted using data from AKI patients admitted to Tongji Hospital (July 2012–April 2024)....
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Frontiers Media S.A.
2025-06-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1554213/full |
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| author | Lixiang Rao Jiazheng Sun Xingyang Zhao Shuwang Ge Ningxu Li |
| author_facet | Lixiang Rao Jiazheng Sun Xingyang Zhao Shuwang Ge Ningxu Li |
| author_sort | Lixiang Rao |
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| description | ObjectivesTo investigate the longitudinal D-dimer trajectories in hospitalized acute kidney injury (AKI) patients and analyze their association with in-hospital mortality risk.MethodsA retrospective study was conducted using data from AKI patients admitted to Tongji Hospital (July 2012–April 2024). General information, laboratory results, and outcomes were extracted from the medical record system. Patients with at least three D-dimer measurements within 30 days after AKI onset were included. Several latent class trajectory models (LCTMs) were constructed to identify distinct longitudinal dynamic trajectories of D-dimer. Model fit was assessed using Akaike Information Criterion, Bayesian information criterion, entropy, category probability and the optimal model was selected. Logistic regression and Kaplan-Meier survival analysis were employed to evaluate the relationship between D-dimer trajectories and in-hospital mortality. Subgroup analyses were performed to explore potential interactions between D-dimer trajectories and other variables.ResultsBased on LCTMs evaluation, the model fitting indices were comprehensively analyzed, and a two-class model was identified as the optimal LCTM. The dynamic trajectories revealed two distinct patterns: an early peak followed by a gradual decline and a low-level continuous stability after AKI onset. Accordingly, patients were categorized into the high-peak decline group and the sustained low-level group. Logistic regression analysis demonstrated that AKI patients in the high-peak decline group had a significantly increased risk of in-hospital mortality (OR 2.27, 95% CI: 1.94–2.65). Kaplan-Meier survival curves indicated a reduced in-hospital survival rate in the high-peak decline group (p < 0.05). Subgroup analyses showed that, across age, gender, chronic kidney disease, cancer, surgery, myocardial infarction, and cerebral infarction subgroups, the high-peak decline group exhibited a significantly elevated risk of in-hospital mortality (p < 0.05), with no significant interaction effects observed among subgroups (p > 0.05).ConclusionUsing LCTM analysis, it was determined that D-dimer exhibits two characteristic longitudinal dynamic trajectories following AKI onset: an early peak followed by a gradual decline and a continuous low-level stability. Among these, the trajectory characterized by an early peak followed by a decline in AKI patients was associated with an increased risk of in-hospital mortality and reduced in-hospital survival, independent of age, gender, chronic kidney disease, cancer, surgery, myocardial infarction, or cerebral infarction. |
| format | Article |
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| institution | OA Journals |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-06-01 |
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| spelling | doaj-art-8e8519b6debd4a8d9031df51183a94562025-08-20T02:24:15ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-06-011210.3389/fmed.2025.15542131554213Association between D-dimer and in-hospital mortality risk in Acute Kidney Injury based on latent class dynamic trajectoryLixiang Rao0Jiazheng Sun1Xingyang Zhao2Shuwang Ge3Ningxu Li4Division of Nephrology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDivision of Pneumology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDivision of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDivision of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDivision of Nephrology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaObjectivesTo investigate the longitudinal D-dimer trajectories in hospitalized acute kidney injury (AKI) patients and analyze their association with in-hospital mortality risk.MethodsA retrospective study was conducted using data from AKI patients admitted to Tongji Hospital (July 2012–April 2024). General information, laboratory results, and outcomes were extracted from the medical record system. Patients with at least three D-dimer measurements within 30 days after AKI onset were included. Several latent class trajectory models (LCTMs) were constructed to identify distinct longitudinal dynamic trajectories of D-dimer. Model fit was assessed using Akaike Information Criterion, Bayesian information criterion, entropy, category probability and the optimal model was selected. Logistic regression and Kaplan-Meier survival analysis were employed to evaluate the relationship between D-dimer trajectories and in-hospital mortality. Subgroup analyses were performed to explore potential interactions between D-dimer trajectories and other variables.ResultsBased on LCTMs evaluation, the model fitting indices were comprehensively analyzed, and a two-class model was identified as the optimal LCTM. The dynamic trajectories revealed two distinct patterns: an early peak followed by a gradual decline and a low-level continuous stability after AKI onset. Accordingly, patients were categorized into the high-peak decline group and the sustained low-level group. Logistic regression analysis demonstrated that AKI patients in the high-peak decline group had a significantly increased risk of in-hospital mortality (OR 2.27, 95% CI: 1.94–2.65). Kaplan-Meier survival curves indicated a reduced in-hospital survival rate in the high-peak decline group (p < 0.05). Subgroup analyses showed that, across age, gender, chronic kidney disease, cancer, surgery, myocardial infarction, and cerebral infarction subgroups, the high-peak decline group exhibited a significantly elevated risk of in-hospital mortality (p < 0.05), with no significant interaction effects observed among subgroups (p > 0.05).ConclusionUsing LCTM analysis, it was determined that D-dimer exhibits two characteristic longitudinal dynamic trajectories following AKI onset: an early peak followed by a gradual decline and a continuous low-level stability. Among these, the trajectory characterized by an early peak followed by a decline in AKI patients was associated with an increased risk of in-hospital mortality and reduced in-hospital survival, independent of age, gender, chronic kidney disease, cancer, surgery, myocardial infarction, or cerebral infarction.https://www.frontiersin.org/articles/10.3389/fmed.2025.1554213/fullacute kidney injuryD-dimerlatent class trajectory modelin-hospital mortality riskdynamic trajectories |
| spellingShingle | Lixiang Rao Jiazheng Sun Xingyang Zhao Shuwang Ge Ningxu Li Association between D-dimer and in-hospital mortality risk in Acute Kidney Injury based on latent class dynamic trajectory Frontiers in Medicine acute kidney injury D-dimer latent class trajectory model in-hospital mortality risk dynamic trajectories |
| title | Association between D-dimer and in-hospital mortality risk in Acute Kidney Injury based on latent class dynamic trajectory |
| title_full | Association between D-dimer and in-hospital mortality risk in Acute Kidney Injury based on latent class dynamic trajectory |
| title_fullStr | Association between D-dimer and in-hospital mortality risk in Acute Kidney Injury based on latent class dynamic trajectory |
| title_full_unstemmed | Association between D-dimer and in-hospital mortality risk in Acute Kidney Injury based on latent class dynamic trajectory |
| title_short | Association between D-dimer and in-hospital mortality risk in Acute Kidney Injury based on latent class dynamic trajectory |
| title_sort | association between d dimer and in hospital mortality risk in acute kidney injury based on latent class dynamic trajectory |
| topic | acute kidney injury D-dimer latent class trajectory model in-hospital mortality risk dynamic trajectories |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1554213/full |
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