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Incidence, risk factors and outcomes of acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF) of underlying cirrhosis.
Hepatol Int 2016; 10(5):807-18HI

Abstract

BACKGROUND AND AIMS

Acute kidney injury (AKI) is a life-threatening complication in patients with acute-on-chronic liver failure (ACLF) of underlying cirrhosis. However, the characteristics of AKI in these patients have not been clarified. Our aim was to determine the incidence and risk factors of AKI and the association between AKI severity and 180-day transplant-free survival.

METHODS

We performed a retrospective cohort analysis of patients with ACLF of underlying cirrhosis in a single center from January 2009 through December 2014. AKI was defined by the criteria proposed by International Club of Ascites (ICA). The incidence and risk factors of AKI development and its relationship to 180-day transplant-free survival rates were evaluated.

RESULTS

Of 1032 patients with ACLF of underlying cirrhosis, 121 (11.72 %) had AKI at admission, and 319 (30.9 %) developed AKI during hospitalization. We established a logistic regression model including four independent factors with AKI development: MELD score [odds ratio (OR), 1.1; 95 % confidence interval (CI), 1.07-1.14], presence of ascites (OR, 3.80; 95 % CI, 2.13-6.78), sepsis/infection (OR, 2.25; 95 % CI, 1.66-3.03) and acute variceal bleed (OR, 1.78; 95 % CI, 1.00-3.19). The area under receiver operating characteristics of the model in internal and external validations were 0.95 and 0.85, respectively. Patients with mild-A AKI had a higher 180-day transplant-free survival rate (23.8 %) than patients with mild-B AKI (19.0 %) or marked AKI (5.9 %) (all p < 0.001). AKI patients with a peak value of sCr <1.5 mg/dl had higher 180-day transplant-free survival rates compared to those with a peak value of sCr ≧1.5 mg/dl (23.8 % vs. 14.7 %, p < 0.001).

CONCLUSIONS

We developed a clinical risk model for predicting development of AKI with great accuracy. Combining the ICA-AKI criteria and the peak value of sCr with 1.5 mg/dl provides a good prognostic method for patients with ACLF of underlying cirrhosis.

Authors+Show Affiliations

Liver Transplantation and Research Center of Beijing 302 Hospital, No. 100 West 4th Middle Road, Fengtai District, Beijing, 100039, China.Liver Failure Treatment and Research Center of Beijing 302 Hospital, No. 100 West 4th Middle Road, Fengtai District, Beijing, 100039, China.Liver Transplantation and Research Center of Beijing 302 Hospital, No. 100 West 4th Middle Road, Fengtai District, Beijing, 100039, China.Liver Failure Treatment and Research Center of Beijing 302 Hospital, No. 100 West 4th Middle Road, Fengtai District, Beijing, 100039, China.Liver Failure Treatment and Research Center of Beijing 302 Hospital, No. 100 West 4th Middle Road, Fengtai District, Beijing, 100039, China.Liver Failure Treatment and Research Center of Beijing 302 Hospital, No. 100 West 4th Middle Road, Fengtai District, Beijing, 100039, China. wanzhihong302@163.com.Liver Failure Treatment and Research Center of Beijing 302 Hospital, No. 100 West 4th Middle Road, Fengtai District, Beijing, 100039, China. xinshaojie302@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27485174

Citation

Zang, Hong, et al. "Incidence, Risk Factors and Outcomes of Acute Kidney Injury (AKI) in Patients With Acute-on-chronic Liver Failure (ACLF) of Underlying Cirrhosis." Hepatology International, vol. 10, no. 5, 2016, pp. 807-18.
Zang H, Liu F, Liu H, et al. Incidence, risk factors and outcomes of acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF) of underlying cirrhosis. Hepatol Int. 2016;10(5):807-18.
Zang, H., Liu, F., Liu, H., You, S., Zhu, B., Wan, Z., & Xin, S. (2016). Incidence, risk factors and outcomes of acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF) of underlying cirrhosis. Hepatology International, 10(5), pp. 807-18. doi:10.1007/s12072-016-9756-z.
Zang H, et al. Incidence, Risk Factors and Outcomes of Acute Kidney Injury (AKI) in Patients With Acute-on-chronic Liver Failure (ACLF) of Underlying Cirrhosis. Hepatol Int. 2016;10(5):807-18. PubMed PMID: 27485174.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence, risk factors and outcomes of acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF) of underlying cirrhosis. AU - Zang,Hong, AU - Liu,Fangfang, AU - Liu,Hongling, AU - You,Shaoli, AU - Zhu,Bing, AU - Wan,Zhihong, AU - Xin,Shaojie, Y1 - 2016/08/02/ PY - 2016/03/18/received PY - 2016/07/14/accepted PY - 2016/8/4/entrez PY - 2016/8/4/pubmed PY - 2017/5/13/medline KW - Acute kidney injury KW - Acute-on-chronic liver failure KW - Cirrhosis KW - Serum creatinine SP - 807 EP - 18 JF - Hepatology international JO - Hepatol Int VL - 10 IS - 5 N2 - BACKGROUND AND AIMS: Acute kidney injury (AKI) is a life-threatening complication in patients with acute-on-chronic liver failure (ACLF) of underlying cirrhosis. However, the characteristics of AKI in these patients have not been clarified. Our aim was to determine the incidence and risk factors of AKI and the association between AKI severity and 180-day transplant-free survival. METHODS: We performed a retrospective cohort analysis of patients with ACLF of underlying cirrhosis in a single center from January 2009 through December 2014. AKI was defined by the criteria proposed by International Club of Ascites (ICA). The incidence and risk factors of AKI development and its relationship to 180-day transplant-free survival rates were evaluated. RESULTS: Of 1032 patients with ACLF of underlying cirrhosis, 121 (11.72 %) had AKI at admission, and 319 (30.9 %) developed AKI during hospitalization. We established a logistic regression model including four independent factors with AKI development: MELD score [odds ratio (OR), 1.1; 95 % confidence interval (CI), 1.07-1.14], presence of ascites (OR, 3.80; 95 % CI, 2.13-6.78), sepsis/infection (OR, 2.25; 95 % CI, 1.66-3.03) and acute variceal bleed (OR, 1.78; 95 % CI, 1.00-3.19). The area under receiver operating characteristics of the model in internal and external validations were 0.95 and 0.85, respectively. Patients with mild-A AKI had a higher 180-day transplant-free survival rate (23.8 %) than patients with mild-B AKI (19.0 %) or marked AKI (5.9 %) (all p < 0.001). AKI patients with a peak value of sCr <1.5 mg/dl had higher 180-day transplant-free survival rates compared to those with a peak value of sCr ≧1.5 mg/dl (23.8 % vs. 14.7 %, p < 0.001). CONCLUSIONS: We developed a clinical risk model for predicting development of AKI with great accuracy. Combining the ICA-AKI criteria and the peak value of sCr with 1.5 mg/dl provides a good prognostic method for patients with ACLF of underlying cirrhosis. SN - 1936-0541 UR - https://www.unboundmedicine.com/medline/citation/27485174/Incidence_risk_factors_and_outcomes_of_acute_kidney_injury__AKI__in_patients_with_acute_on_chronic_liver_failure__ACLF__of_underlying_cirrhosis_ L2 - https://dx.doi.org/10.1007/s12072-016-9756-z DB - PRIME DP - Unbound Medicine ER -