Development and validation of an early prediction model for bee-sting-induced acute kidney injury using machine learning.

Acute kidney injury (AKI) is a severe and frequent complication following bee stings, with a reported incidence of 30-50%. Early identification is clinically challenging due to the delayed rise in serum creatinine. This retrospective study aimed to develop and validate an interpretable machine learning model for the early prediction of AKI in bee-sting patients. We included 305 patients admitted between January 2018 and September 2025, of whom 99 (32.5%) developed AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed for feature selection from 33 baseline variables, identifying eight key predictors, including lactate, creatinine, and dark urine. Six machine learning algorithms - logistic regression, random forest, support vector machine, neural network, extreme gradient boosting (XGBoost), and light gradient boosting machine - were developed and evaluated. The XGBoost model demonstrated superior performance, achieving an area under the receiver operating characteristic curve of 0.964 and an accuracy of 92.6% on the test set. SHapley Additive exPlanations analysis was applied to interpret the optimal model, highlighting creatinine, lactate dehydrogenase, lactate, and dark urine as the most influential predictors. A clinically applicable nomogram was constructed and showed good calibration and utility. In conclusion, this study successfully developed a high-performance and interpretable XGBoost model for early prediction of bee-sting-induced AKI. The validated nomogram provides an accessible bedside decision-support tool to facilitate timely risk stratification and intervention, potentially improving patient outcomes.