Development and validation of an interpretable machine learning model for predicting acute kidney injury after pancreatic surgery

doi:10.3748/wjg.v32.i19.116271

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May 21, 2026 (publication date) through May 23, 2026

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. May 21, 2026; 32(19): 116271
Published online May 21, 2026. doi: 10.3748/wjg.v32.i19.116271

Table 1 Characteristics of the patient cohorts, n (%)

Variables	Overall cohort			P value	Training cohort (n = 370)	Validation cohort (n = 94)	P value
Variables	Total (n = 464)	AKI (n = 230)	Non-AKI (n = 234)	P value	Training cohort (n = 370)	Validation cohort (n = 94)	P value
Demographic data
Age (years), median (IQR)	64 (56 to 69)	65 (57 to 70)	63 (55 to 68)	0.118	63.5 (56 to 69)	64 (57 to 70)	0.402
Male	285 (61)	143 (62)	142 (61)	0.742	229 (63)	56 (57)	0.327
BMI (kg/m²), median (IQR)	23.05 (20.81 to 25.30)	23.02 (20.89 to 25.80)	23.10 (20.77 to 24.65)	0.210	23.04 (20.76 to 25.35)	23.38 (20.94 to 25.00)	0.991
Smoking	150 (32)	69 (30)	81 (35)	0.288	118 (32)	32 (33)	0.938
Drinking	133 (29)	63 (27)	70 (30)	0.548	107 (29)	26 (27)	0.599
Medical history
HTN	173 (37)	90 (39)	83 (35)	0.415	130 (36)	43 (44)	0.129
DM	139 (30)	76 (33)	63 (27)	0.150	107 (29)	32 (33)	0.512
CHD	50 (11)	36 (16)	14 (6)	< 0.001	34 (9)	16 (16)	0.046
Stroke	30 (6)	11 (5)	19 (8)	0.144	21 (6)	9 (9)	0.218
Pancreatitis	36 (8)	17 (7)	19 (8)	0.769	21 (6)	15 (15)	0.002
Jaundice	155 (33)	82 (36)	73 (31)	0.309	119 (33)	36 (37)	0.431
Malignancy history	38 (8)	28 (12)	10 (4)	0.002	24 (7)	14 (14)	0.013
CKD of G1/G2	6 (1)	6 (3)	0 (0)	0.013	4 (1)	2 (2)	0.461
Abdominal surgery history	139 (30)	72 (31)	67 (29)	0.530	100 (27)	39 (40)	0.017
Preoperative medication
NSAIDs	19 (4)	17 (7)	2 (1)	< 0.001	13 (4)	6 (6)	0.254
ACEI/ARB	67 (14)	35 (15)	32 (14)	0.637	45 (12)	22 (22)	0.011
Neoadjuvant	18 (4)	9 (4)	9 (4)	0.970	16 (4)	2 (2)	0.289
Preoperative laboratory findings
HGB (g/L), median (IQR)	130 (119 to 141)	129 (117 to 141)	131 (120 to 141)	0.169	130 (119 to 141)	131 (117 to 142)	0.685
WBC (× 10⁹/L), median (IQR)	5.74 (4.79 to 6.83)	5.75 (4.86 to 7.11)	5.74 (4.72 to 6.64)	0.600	5.80 (4.86 to 6.82)	5.55 (4.53 to 6.91)	0.210
PLT (× 10⁹/L), median (IQR)	211 (172 to 252)	210 (163 to 249)	212.5 (178 to 259)	0.181	214 (173 to 251)	200 (166 to 257)	0.240
ALT (U/L), median (IQR)	31 (16 to 82)	32.5 (16 to 79)	28.5 (15 to 84)	0.524	31.5 (16 to 82)	27.5 (14 to 76)	0.891
Alb (g/L), median (IQR)	40 (37 to 43)	40 (37 to 43)	41 (37 to 43)	0.416	40 (37 to 43)	40 (37 to 44)	0.904
TBil (μmol/L), median (IQR)	15.15 (10.00 to 50.90)	17.75 (9.80 to 70.30)	14.05 (10.20 to 39.00)	0.067	15.15 (9.60 to 54.90)	15.15 (11.00 to 42.40)	0.659
SCr (μmol/L), median (IQR)	64 (54 to 73)	64 (54 to 73)	64 (56 to 72)	0.806	64 (55 to 73)	64 (53 to 72)	0.393
Urea (μmol/L), median (IQR)	4.59 (3.78 to 5.81)	4.77 (3.94 to 6.01)	4.43 (3.57 to 5.56)	0.014	4.57 (3.78 to 5.79)	4.62 (3.79 to 5.84)	0.600
hsCRP (mg/L), median (IQR)	1.97 (0.84 to 5.82)	1.97 (0.85 to 5.49)	1.97 (0.75 to 6.16)	0.847	2.10 (0.84 to 7.32)	1.72 (0.87 to 4.32)	0.305
PT (seconds), median (IQR)	11.8 (11.4 to 12.5)	11.9 (11.4 to 12.6)	11.7 (11.3 to 12.3)	0.024	11.9 (11.4 to 12.5)	11.7 (11.3 to 12.3)	0.362
APTT (seconds), median (IQR)	26.8 (25.2 to 28.9)	27.0 (25.2 to 29.0)	26.5 (25.1 to 28.7)	0.133	26.85 (25.2 to 28.9)	26.55 (25.1 to 28.5)	0.633
CA19-9 (U/mL), median (IQR)	50.5 (14.6 to 189.0)	66.7 (18.8 to 284.6)	39.5 (11.8 to 145.0)	0.004	49.9 (14.2 to 181.5)	50.8 (17.2 to 199.0)	0.613
CEA (U/mL), median (IQR)	2.53 (1.67 to 4.30)	2.67 (1.70 to 4.61)	2.39 (1.61 to 3.90)	0.066	2.50 (1.67 to 4.30)	2.62 (1.66 to 4.37)	0.856
Preoperative imaging findings
Tumor length (cm), median (IQR)	2.7 (1.8 to 3.8)	3.0 (2.0 to 4.0)	2.5 (1.7 to 3.5)	0.002	2.7 (1.8 to 3.8)	2.9 (1.8 to 4.0)	0.979
ASA physical status ≥ III	107 (24)	63 (29)	44 (19)	0.017	85 (23)	24 (24)	0.793
Type of surgery
PD	361 (78)	180 (78)	181 (77)	0.813	285 (78)	76 (78)	0.946
DP/TP	103 (22)	50 (22)	53 (23)		81 (22)	22 (22)
Open surgery	259 (56)	143 (62)	116 (50)	0.006	209 (57)	50 (51)	0.281
Laparoscope/robotic	205 (44)	87 (38)	118 (50)		157 (43)	48 (49)
Intraoperative variables
Duration of surgery (hour), median (IQR)	4.50 (4.13 to 6.75)	5.29 (4.50 to 7.33)	4.50 (4.00 to 5.42)	< 0.001	4.50 (4.08 to 6.75)	4.94 (4.33 to 7.00)	0.332
Vein reconstruction	39 (8)	27 (12)	12 (5)	0.010	32 (9)	7 (7)	0.612
Artery reconstruction	9 (2)	7 (3)	2 (1)	0.087	3 (1)	6 (6)	< 0.001
Multi-organ resection	40 (9)	27 (12)	13 (6)	0.018	29 (8)	11 (11)	0.301
Blood loss (mL), median (IQR)	400 (200 to 800)	500 (300 to 800)	400 (200 to 650)	< 0.001	400 (200 to 800)	400 (200 to 800)	0.877
Crystalloid (mL), median (IQR)	3100 (2300 to 3700)	3200 (2600 to 3900)	2800 (2200 to 3600)	< 0.001	3100 (2300 to 3700)	3100 (2300 to 3700)	0.820
Colloidal (mL), median (IQR)	1000 (500 to 1000)	1000 (500 to 1000)	500 (500 to 1000)	0.152	500 (500 to 1000)	1000 (500 to 1000)	0.145
RBC transfusion (mL), median (IQR)	0 (0 to 800)	400 (0 to 800)	0 (0 to 400)	< 0.001	0 (0 to 550)	0 (0 to 800)	0.171
Plasma transfusion (mL), median (IQR)	0 (0 to 400)	0 (0 to 400)	0 (0 to 400)	< 0.001	0 (0 to 400)	0 (0 to 400)	0.069
Urine output (mL), median (IQR)	600 (400 to 1100)	700 (400 to 1100)	600 (400 to 1000)	0.370	600 (400 to 1000)	800 (400 to 1300)	0.126
Postoperative laboratory findings
HGB (g/L), median (IQR)	116 (105 to 129)	116 (105 to 126)	117 (106 to 131)	0.112	116 (105 to 129)	117 (106 to 129)	0.400
WBC (× 10⁹/L), median (IQR)	12.18 (9.85 to 15.05)	12.53 (10.06 to 15.81)	11.85 (9.68 to 14.04)	0.036	12.29 (10.08 to 15.24)	11.52 (9.05 to 13.87)	0.022
PLT (× 10⁹/L), median (IQR)	180 (143 to 215)	177 (132 to 209)	182 (151 to 219)	0.064	180 (143 to 219)	180 (137 to 209)	0.371
Alb (g/L), median (IQR)	32 (29 to 35)	31 (28 to 35)	33 (29 to 36)	0.002	32 (29 to 36)	32 (29 to 34)	0.360
TBil (μmol/L), median (IQR)	20.9 (14.1 to 47.1)	25.4 (15.1 to 61.7)	18.6 (13.2 to 35.9)	< 0.001	21.0 (14.3 to 48.6)	20.5 (13.5 to 41.2)	0.520
SCr (μmol/L), median (IQR)	63 (52 to 77)	67 (52 to 83)	61 (52 to 72)	0.005	63 (52 to 76)	64 (50 to 77)	0.607
Urea (μmol/L), median (IQR)	4.12 (3.14 to 5.42)	4.44 (3.42 to 5.57)	3.87 (2.99 to 5.08)	< 0.001	4.13 (3.14 to 5.42)	4.08 (3.11 to 5.48)	0.718
PT (seconds), median (IQR)	12.8 (12.3 to 13.6)	13.0 (12.3 to 13.8)	12.8 (12.2 to 13.5)	0.016	12.8 (12.2 to 13.5)	13.0 (12.3 to 13.8)	0.245
APTT (seconds), median (IQR)	27.5 (25.2 to 30.9)	27.6 (25.3 to 31.1)	27.4 (24.8 to 30.7)	0.315	27.4 (25.2 to 30.6)	27.9 (25.3 to 32.0)	0.366
Postoperative fluid management
Total input on POD0 (mL/kg), median (IQR)	89.34 (72.85 to 115.45)	93.79 (74.42 to 126.07)	86.12 (71.65 to 106.30)	0.004	88.52 (72.85 to 111.50)	96.79 (73.03 to 128.95)	0.044
Input on POD1 (mL/kg), median (IQR)	44.58 (37.72 to 51.69)	44.54 (36.51 to 50.87)	44.59 (38.68 to 53.22)	0.464	44.37 (36.92 to 51.60)	45.72 (40.37 to 52.08)	0.150
Output on POD1 (mL/kg), median (IQR)	33.96 (26.91 to 43.87)	34.12 (27.55 to 44.73)	33.41 (26.54 to 42.57)	0.446	33.30 (26.35 to 42.57)	35.89 (28.72 to 48.27)	0.040
Net fluid of POD1 (mL/kg), median (IQR)	8.94 (0.65 to 17.38)	8.34 (-0.19 to 17.75)	9.65 (1.96 to 16.86)	0.281	9.00 (1.54 to 17.51)	8.45 (-2.6 to 16.38)	0.185
Input on POD2 (mL/kg), median (IQR)	43.08 (36.34 to 49.25)	43.60 (35.34 to 49.70)	42.90 (37.07 to 48.53)	0.765	43.07 (36.25 to 49.19)	43.21 (36.54 to 49.26)	0.613
Output on POD2 (mL/kg), median (IQR)	32.07 (24.25 to 42.38)	34.98 (24.92 to 44.00)	29.18 (23.54 to 39.51)	0.002	31.82 (24.06 to 42.08)	32.69 (24.34 to 47.55)	0.336
Net fluid of POD2 (mL/kg), median (IQR)	9.49 (0.23 to 18.26)	8.23 (-1.37 to 16.28)	10.64 (3.01 to 19.32)	0.002	9.68 (0.33 to 18.49)	9.23 (-0.09 to 17.42)	0.329
Input on POD3 (mL/kg), median (IQR)	40.99 (34.59 to 47.51)	41.81 (34.01 to 49.09)	40.50 (35.22 to 46.51)	0.396	40.69 (34.60 to 47.22)	41.65 (34.16 to 49.21)	0.475
Output on POD3 (mL/kg), median (IQR)	30.95 (23.98 to 40.10)	33.11 (24.68 to 44.13)	29.30 (22.57 to 38.05)	< 0.001	30.63 (24.14 to 39.65)	31.99 (23.86 to 43.75)	0.426
Net fluid of POD3 (mL/kg), median (IQR)	9.55 (2.35 to 17.76)	7.17 (0.48 to 16.51)	11.92 (4.32 to 18.85)	< 0.001	9.51 (2.28 to 17.60)	10.27 (2.59 to 17.85)	0.865
Postoperative complications
CR-POPF	77 (17)	47 (20)	30 (13)	0.028	56 (15)	21 (21)	0.148
PPH grades B and C	75 (16)	59 (26)	16 (7)	< 0.001	58 (16)	17 (17)	0.720
Abdominal infection	96 (21)	77 (33)	19 (8)	< 0.001	73 (20)	23 (23)	0.444
Shock	57 (12)	54 (23)	3 (1)	< 0.001	42 (11)	15 (15)	0.305
DGE grades B and C	89 (19)	47 (21)	42 (18)	0.454	72 (20)	18 (18)	0.772
Undesirable healing	23 (5)	12 (5)	11 (5)	0.798	17 (5)	6 (6)	0.549
BL	27 (6)	17 (7)	10 (4)	0.148	24 (7)	3 (3)	0.189
Gas/intestinal fistula	7 (2)	6 (3)	1 (0)	0.054	5 (1)	2 (2)	0.627
Clinical outcome
AKI stage							0.556
I		190 (83)			152 (84)	38 (78)
II		23 (10)			17 (9)	6 (12)
III		17 (7)			11 (6)	6 (12)
AKI onset time (POD) (days)		4 (2 to 10)			3 (1 to 8)	3 (2 to 8)
Length of ICU stay (days), median (IQR)	1.74 (4.05)	2.93 (5.43)	0.56 (0.89)	< 0.001	1.76 (4.21)	1.66 (3.37)	0.745
Length of hospital stay (days), median (IQR)	23 (17 to 34)	29 (18 to 44)	20 (15 to 28)	< 0.001	22 (17 to 34)	24 (17 to 33)	0.637
Reoperation	40 (9)	35 (15)	5 (2)	< 0.001	29 (8)	11 (11)	0.301
In-hospital mortality	12 (3)	12 (5)	0 (0)	< 0.001	11 (3)	1 (1)	0.272

AKI: Acute kidney injury; BMI: Body mass index; IQR: Interquartile range; HTN: Hypertension; CHD: Coronary heart disease; DM: Diabetes mellitus; ACEI: Angiotensin-converting enzyme inhibitors; CKD: Chronic kidney disease; NSAID: Nonsteroidal anti-inflammatory drugs; ARB: Angiotensin receptor blockers; HGB: Hemoglobin; ALT: Alanine aminotransferase; PLT: Platelet count; WBC: White blood cell; Alb: Albumin; TBil: Total bilirubin; hsCRP: High-sensitivity C-reactive protein; SCr: Serum creatinine; PT: Prothrombin time; APTT: Activated partial thromboplastin time; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; ASA: American Society of Anesthesiologists; PD: Pancreaticoduodenectomy; DP: Distal pancreatectomy; TP: Total pancreatectomy; POD: Postoperative day; CR-POPF: Clinically relevant postoperative pancreatic fistula; RBC: Red blood cell; DGE: Delayed gastric emptying; PPH: Post-pancreatectomy hemorrhage; BL: Bile leak; ICU: Intensive care unit.

Full Size Table

Table 2 Subgroup analysis of stage I and stage II/III acute kidney injury, n (%)

Variables	All AKI (n = 230)	Stage I AKI (n = 190)	Stage II and III AKI (n = 40)	P value
Age (years), median (IQR)	65 (57 to 70)	65 (57 to 69)	65 (56 to 72)	0.721
Male	143 (62)	117 (62)	26 (65)	0.690
BMI (kg/m²), median (IQR)	23.02 (20.89 to 25.80)	23.18 (21.08 to 25.83)	22.94 (20.71 to 25.23)	0.644
HTN	90 (39)	68 (36)	22 (55)	0.024
Drinking	63 (27)	47 (25)	16 (40)	0.049
Preoperative variables
PT (seconds), median (IQR)	11.9 (11.4 to 12.6)	11.9 (11.4 to 12.5)	12.2 (11.7 to 12.7)	0.081
APTT (seconds), median (IQR)	27.0 (25.2 to 29.0)	26.8 (25.1 to 28.7)	27.6 (26.3 to 30.2)	0.051
Postoperative variables
PT (seconds), median (IQR)	13.0 (12.3 to 13.8)	12.9 (12.3 to 13.7)	13.1 (12.2 to 14.3)	0.316
APTT (seconds), median (IQR)	27.7 (25.3 to 31.1)	27.5 (25.3 to 30.5)	30.5 (26.3 to 35.6)	0.013
Postoperative complications
CR-POPF	47 (20)	32 (17)	15 (38)	0.003
PPH, grade B and C	59 (26)	43 (23)	16 (40)	0.022
DGE, grade B and C	47 (20)	34 (18)	13 (33)	0.037
Abdominal infection	77 (33)	56 (29)	21 (53)	0.005
Shock	54 (23)	39 (21)	15 (38)	0.021
Clinical outcomes
Length of hospital stay (days), median (IQR)	29 (18 to 44)	27 (18 to 39)	43 (28 to 53)	< 0.001
Length of ICU stay (days), median (IQR)	1 (0 to 3)	1 (0 to 3)	3 (1 to 5)	0.017
In-hospital mortality	12 (5)	6 (3)	6 (15)	< 0.001

AKI: Acute kidney injury; BMI: Body mass index; IQR: Interquartile range; HTN: Hypertension; PT: Prothrombin time; APTT: Activated partial thromboplastin time; CR-POPF: Clinically relevant postoperative pancreatic fistula; DGE: Delayed gastric emptying; PPH: Post-pancreatectomy hemorrhage; ICU: Intensive care unit.

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Table 3 Machine learning evaluation metrics for the training and validation cohorts

Models	AUC (95%CI)	Accuracy	Sensitivity	Specificity	Brier score
Developing set
CatBoost	0.803 (0.759, 0.848)	0.738	0.780	0.710	0.180
KNN	0.772 (0.725, 0.819)	0.703	0.791	0.609	0.195
LightGBM	0.786 (0.740, 0.832)	0.722	0.764	0.676	0.192
LR	0.776 (0.728, 0.824)	0.724	0.754	0.693	0.189
RF	0.782 (0.735, 0.828)	0.719	0.780	0.654	0.191
SVM	0.765 (0.716, 0.813)	0.700	0.733	0.665	0.197
XGBoost	0.781 (0.734, 0.827)	0.730	0.780	0.676	0.191
Validation set
CatBoost	0.751 (0.652, 0.850)	0.702	0.767	0.647	0.203
KNN	0.655 (0.544, 0.766)	0.596	0.674	0.529	0.232
LightGBM	0.756 (0.657, 0.854)	0.681	0.651	0.706	0.203
LR	0.709 (0.605, 0.812)	0.617	0.651	0.589	0.218
RF	0.712 (0.607, 0.817)	0.628	0.651	0.608	0.216
SVM	0.714 (0.611, 0.817)	0.638	0.674	0.608	0.212
XGBoost	0.730 (0.627, 0.833)	0.681	0.674	0.686	0.210

AUC: Area under the curve; CI: Confidence interval; CatBoost: Categorical boosting; KNN: K-nearest neighbor; LightGBM: Light gradient boosting machine; LR: Logistic regression; RF: Random forest; SVM: Support vector machine; XGBoost: Extreme gradient boosting with classification trees.

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Citation: Lin C, Fu RK, Zheng H, Li TY, Han JS, Margonis GA, Wang JJ, Dong LB, Wang NS, Sun YX, Wang YZ, Liu C, Xu Q, Han XL, Zhang TP, Guo JC, Dai MH, Xia P, Chen LM, Wang WB. Development and validation of an interpretable machine learning model for predicting acute kidney injury after pancreatic surgery. World J Gastroenterol 2026; 32(19): 116271
URL: https://www.wjgnet.com/1007-9327/full/v32/i19/116271.htm
DOI: https://dx.doi.org/10.3748/wjg.v32.i19.116271

Lin C, Fu RK, Zheng H, Li TY, Han JS, Margonis GA, Wang JJ, Dong LB, Wang NS, Sun YX, Wang YZ, Liu C, Xu Q, Han XL, Zhang TP, Guo JC, Dai MH, Xia P, Chen LM, Wang WB. Development and validation of an interpretable machine learning model for predicting acute kidney injury after pancreatic surgery. World J Gastroenterol 2026; 32(19): 116271 [DOI: 10.3748/wjg.v32.i19.116271]

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