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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 2
Feb.  2023
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Article Navigation >  Journal of Clinical Hepatology  > 2023  >  39(2): 359-364

Influencing factors for acute kidney injury in acute liver failure and establishment of a predictive model

DOI: 10.3969/j.issn.1001-5256.2023.02.016

  • Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

Research funding:

National Science Foundation for Distinguished Young Scholar (82002552)

More Information
  • Corresponding author: CHEN Yongzhong, 15201664470@163.com (ORCID: 0000-0001-66601-3304); BAO Jie, fccbaoj@zzu.edu.cn (ORCID: 0000-0002-9145-9911)
  • Received Date: 2022-07-13
  • Accepted Date: 2022-08-03
  • Published Date: 2023-02-20
    Abstract
  •   Objective  To investigate the predictive factors for acute kidney injury (AKI) in patients with acute liver failure (ALF), and to establish a new predictive model.  Methods  Clinical data were collected from 253 patients who were diagnosed with ALF in The First Affiliated Hospital of Zhengzhou University from January 2015 to October 2021, and according to the presence or absence of AKI, these patients were divided into non-AKI group with 170 patients and AKI group with 83 patients. Related clinical data and laboratory markers were collected. Non-normally distributed continuous data were expressed as M(P25-P75), and the Mann-Whitney U test was used for comparison between two groups; categorical data were expressed as cases (%), and the chi-square test was used for comparison between two groups. The binary logistic regression analysis was used to investigate the risk factors for AKI in ALF patients, and the receiver operating characteristic (ROC) curve was used to evaluate the performance of the indices obtained in predicting AKI in ALF patients.  Results  Compared with the non-AKI group, the AKI group had a significantly higher proportion of patients with hypertension, diabetes, hepatic encephalopathy, ascites, and pulmonary infection, significantly higher levels of white blood cell count (WBC), international normalized ratio (INR), C-reactive protein, procalcitonin (PCT), neutrophil-to-lymphocyte ratio, and Model for End-Stage Liver Disease (MELD) score, and significantly lower levels of platelet count, lymphocyte-to-monocyte ratio, and PNI (all P < 0.05). The multivariate logistic regression analysis showed that WBC (odds ratio [OR]=1.267, 95% confidence interval [CI]: 1.124-1.428, P < 0.001), INR (OR=1.663, 95%CI: 1.205-2.293, P=0.002), PCT (OR=1.416, 95%CI: 1.137-1.764, P=0.002), and MELD score (OR=1.098, 95%CI: 1.029-1.172, P=0.005) were risk factors for the development of AKI in patients with ALF. The ROC curve analysis showed that the combination of WBC+INR+PCT+MELD had the largest area under the ROC curve (AUC) of 0.908 in predicting AKI in ALF patients, while WBC, INR, PCT, and MELD alone had an AUC of 0.776, 0.771, 0.746, and 0.780, respectively, in predicting AKI.  Conclusion  WBC, INR, PCT, and MELD score are independent influencing factors for AKI in patients with ALF, and the predictive model established based on these four indices has a relatively high predictive value.

     

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    • References(20)
  • [1]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, CMA; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, CMA. Guideline for diagnosis and treatment of liver failure[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [2]
    TUJIOS SR, HYNAN LS, VAZQUEZ MA, et al. Risk factors and outcomes of acute kidney injury in patients with acute liver failure[J]. Clin Gastroenterol Hepatol, 2015, 13(2): 352-359. DOI: 10.1016/j.cgh.2014.07.011.
    [3]
    ANGELI P, GINES P, WONG F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites[J]. Gut, 2015, 64(4): 531-537. DOI: 10.1136/gutjnl-2014-308874.
    [4]
    KAMATH PS, WIESNER RH, MALINCHOC M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33(2): 464-470. DOI: 10.1053/jhep.2001.22172.
    [5]
    CHEN J, LIU XY, TONG JJ, et al. Clinical features of patients with acute/subacute liver failure complicated by acute kidney injury[J]. J Clin Hepatol, 2018, 34(2): 364-367. DOI: 10.3969/j.issn.1001-5256.2018.02.029.

    陈婧, 刘晓燕, 童晶晶, 等. 急性/亚急性肝衰竭合并急性肾损伤的临床特征分析[J]. 临床肝胆病杂志, 2018, 34(2): 364-367. DOI: 10.3969/j.issn.1001-5256.2018.02.029.
    [6]
    MOU YD, ZHANG LL, ZHANG PR. New advances in the study of early biological markers of acute kidney injury[J/CD]. Chin J Care Med(Electronic Edition), 2015, 8(3): 191-196. DOI: 10.3877/cma.j.issn.1674-6880.2015.03.013.

    牟迎东, 张琳琳, 张培荣. 急性肾损伤早期生物学标志物研究的新进展[J/CD]. 中华危重症医学杂志(电子版), 2015, 8(3): 191-196. DOI: 10.3877/cma.j.issn.1674-6880.2015.03.013.
    [7]
    de SEIGNEUX S, MARTIN PY. Preventing the progression of AKI to CKD: The role of mitochondria[J]. J Am Soc Nephrol, 2017, 28(5): 1327-1329. DOI: 10.1681/ASN.2017020146.
    [8]
    WADEI HM. Hepatorenal syndrome: a critical update[J]. Semin Respir Crit Care Med, 2012, 33(1): 55-69. DOI: 10.1055/s-0032-1301735.
    [9]
    SHI X, ZHU P, YAN G, et al. Clinical characteristics and long-term outcome of acute kidney injury in patients with HBV-related acute-on-chronic liver failure[J]. J Viral Hepat, 2016, 23(11): 920-929. DOI: 10.1111/jvh.12566.
    [10]
    HAN SS, AHN SY, RYU J, et al. U-shape relationship of white blood cells with acute kidney injury and mortality in critically ill patients[J]. Tohoku J Exp Med, 2014, 232(3): 177-185. DOI: 10.1620/tjem.232.177.
    [11]
    PIERI G, AGARWAL B, BURROUGHS AK. C-reactive protein and bacterial infection in cirrhosis[J]. Ann Gastroenterol, 2014, 27(2): 113-120.
    [12]
    LUO Y, LU JJ, WANG YD, et al. The change of procalcitonin in patients with liver failure and its clinical application value[J]. Chin J Infect Dis, 2021, 39(7): 449-452. DOI: 10.3760/cma.j.cn311365-20200819-00760.

    罗越, 逯晶晶, 王亚东, 等. 肝衰竭患者降钙素原的变化规律及其临床应用价值[J]. 中华传染病杂志, 2021, 39(7): 449-452. DOI: 10.3760/cma.j.cn311365-20200819-00760.
    [13]
    KAN WC, HUANG YT, WU VC, et al. Predictive ability of procalcitonin for acute kidney injury: a narrative review focusing on the interference of infection[J]. Int J Mol Sci, 2021, 22(13). DOI: 10.3390/ijms22136903.
    [14]
    NIE X, TANG JT, CAI B, et al. Analysis of procalcitonin in patients with end stage liver disease complicated with acute kidney injury[J]. Chin J Lab Med, 2013, 36(11): 1018-1021. DOI: 10.3760/cma.j.issn.1009-9158.2013.11.012.

    聂鑫, 唐江涛, 蔡蓓, 等. 终末期肝衰竭伴急性肾损伤患者血清降钙素原水平研究[J]. 中华检验医学杂志, 2013, 36(11): 1018-1021. DOI: 10.3760/cma.j.issn.1009-9158.2013.11.012.
    [15]
    HUANG ZL, GAO ZL. Triple blows and treatment strategies for liver failure[J]. J Intern Intensive Med, 2014, 20(3): 154-156. DOI: 10.11768/nkjwzzzz20140304.

    黄湛镰, 高志良. 肝衰竭的三重打击及治疗策略[J]. 内科急危重症杂志, 2014, 20(3): 154-156. DOI: 10.11768/nkjwzzzz20140304.
    [16]
    HUANG Z, LIN C, FANG J, et al. Acute kidney injury in hepatitis B-related acute-on-chronic liver failure without preexisting liver cirrhosis[J]. Hepatol Int, 2015, 9(3): 416-423. DOI: 10.1007/s12072-015-9636-y.
    [17]
    HU H, HUANG BB, NING L, et al. Establishment and evaluation of a predictive model for short-time prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure[J]. J Clin Hepatol, 2020, 36(1): 123-127. DOI: 10.3969/j.issn.1001-5256.2020.01.027.

    胡辉, 黄贝贝, 宁玲, 等. HBV相关慢加急性肝衰竭患者短期预后预测模型的建立与评价[J]. 临床肝胆病杂志, 2020, 36(1): 123-127. DOI: 10.3969/j.issn.1001-5256.2020.01.027.
    [18]
    WU ZP, ZHONG YB, LI XP, et al. The analysis of acute kidney injury in hepatitis B virus related acute-on-chronic liver failure[J]. Chin J Infect Dis, 2016, 34(12): 713-716. DOI: 10.3760/cma.j.issn.1000-6680.2016.12.003.

    吴振平, 钟渊斌, 李小鹏, 等. 乙型肝炎病毒相关慢加急性(亚急性)肝功能衰竭患者中急性肾损伤的分析[J]. 中华传染病杂志, 2016, 34(12): 713-716. DOI: 10.3760/cma.j.issn.1000-6680.2016.12.003.
    [19]
    ZHANG ZQ, YE YN, HE G, et al. Study of risk factors and high-risk population of acute kidney injury in patients with hepatitis B virus related acute on chronic liver failure[J]. Chin Hepatol, 2019, 24(9): 997-1001, 1006. DOI: 10.3969/j.issn.1008-1704.2019.09.008.

    张志侨, 叶一农, 何纲, 等. 乙型肝炎相关慢加急性肝衰竭患者急性肾损伤的影响因素和高危人群分析[J]. 肝脏, 2019, 24(9): 997-1001, 1006. DOI: 10.3969/j.issn.1008-1704.2019.09.008.
    [20]
    YUAN W, ZHANG YY, ZHANG ZG, et al. Risk factors and outcomes of acute kidney injury in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Am J Med Sci, 2017, 353(5): 452-458. DOI: 10.1016/j.amjms.2017.03.005.
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