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Development of predisposition, injury, response, organ failure model for predicting acute kidney injury in acute on chronic liver failure.
Liver Int 2017; 37(10):1497-1507LI

Abstract

BACKGROUND AND AIM

There is limited data on predictors of acute kidney injury in acute on chronic liver failure. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting acute kidney injury in a multicentric cohort of acute on chronic liver failure patients.

PATIENTS AND METHODS

Data of 2360 patients from APASL-ACLF Research Consortium (AARC) was analysed. Multivariate logistic regression model (PIRO score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of acute on chronic liver failure patients (n=997).

RESULTS

Factors significant for P component were serum creatinine[(≥2 mg/dL)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(<12 mg/dL,OR 1) vs (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) vs (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(<3 mmol/LOR-1) vs (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) vs (≥5 mmol/L,OR 4.34, 95% CI 1.67-11.3)] and blood urea (OR 3.73, 95% CI 2.5-5.5); for I component nephrotoxic medications (OR-9.86, 95% CI 3.2-30.8); for R component,Systemic Inflammatory Response Syndrome,(OR-2.14, 95% CI 1.4-3.3); for O component, Circulatory failure (OR-3.5, 95% CI 2.2-5.5). The PIRO score predicted acute kidney injury with C-index of 0.95 and 0.96 in the derivation and validation cohort. The increasing PIRO score was also associated with mortality (P<.001) in both the derivation and validation cohorts.

CONCLUSIONS

The PIRO model identifies and stratifies acute on chronic liver failure patients at risk of developing acute kidney injury. It reliably predicts mortality in these patients, underscoring the prognostic significance of acute kidney injury in patients with acute on chronic liver failure.

Authors+Show Affiliations

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Clinical Hematology, Command Hospital [Eastern Command], Kolkata, India.Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.UMR_S1149, Center for Research in Inflammation (CRI), Inserm and Paris Diderot University, Paris, France. DHU Unity, Liver unit, Beaujon hospital, APHP, Clichy, France.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Gastroenterology, Ziauddin University Hospital, Karachi, Pakistan.Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research, Mumbai, India.Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.Department of Surgery, Division of Hepatobiliary and Pancreatic surgery, and Liver Transplantation, The University of Hong Kong, Hong Kong, China.Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia.Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.Center for Liver and Digestive Diseases, Hallym University Chuncheon Sacred Heart Hospital, Gangwon-Do, Korea.Department of Medicine, Division of Gastroenterology and Hepatology, Chulalongkorn University, Bangkok, Thailand.Department of Hepatology, The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China.Department of Medicine, National University Health System, Singapore, Singapore.Division of Hepatology, University of Indonesia, Jakarta, Indonesia.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines.Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.Institute of Liver diseases and Transplantation, Global Health city, Chennai, India.Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.Department of Hepatology, Global Hospitals, Mumbai, India.Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt.Department of Gastroenterology, GB Pant Hospital, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology Selayang Hospital, Selangor, Malaysia.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Medicine, The University of Hong Kong, Hong Kong, China.Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.Department of Gastroenterology, St.John's Medical College and Hospital, Bangalore, India.Department of Gastroenterology and Hepatology, CMC, Vellore, India.Department of Gastroenterology, Rome, NY, USA.Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.Department of Gastroenterology, Liver Research Center, Beijing, China.Department of Gastroenterology, Nanjing First Hospital, Nanjing, China.Department of Gastroenterology, East Brunswick, NJ, USA.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Validation Study

Language

eng

PubMed ID

28393476

Citation

Maiwall, Rakhi, et al. "Development of Predisposition, Injury, Response, Organ Failure Model for Predicting Acute Kidney Injury in Acute On Chronic Liver Failure." Liver International : Official Journal of the International Association for the Study of the Liver, vol. 37, no. 10, 2017, pp. 1497-1507.
Maiwall R, Sarin SK, Kumar S, et al. Development of predisposition, injury, response, organ failure model for predicting acute kidney injury in acute on chronic liver failure. Liver Int. 2017;37(10):1497-1507.
Maiwall, R., Sarin, S. K., Kumar, S., Jain, P., Kumar, G., Bhadoria, A. S., ... Chen, Y. (2017). Development of predisposition, injury, response, organ failure model for predicting acute kidney injury in acute on chronic liver failure. Liver International : Official Journal of the International Association for the Study of the Liver, 37(10), pp. 1497-1507. doi:10.1111/liv.13443.
Maiwall R, et al. Development of Predisposition, Injury, Response, Organ Failure Model for Predicting Acute Kidney Injury in Acute On Chronic Liver Failure. Liver Int. 2017;37(10):1497-1507. PubMed PMID: 28393476.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Development of predisposition, injury, response, organ failure model for predicting acute kidney injury in acute on chronic liver failure. AU - Maiwall,Rakhi, AU - Sarin,Shiv Kumar, AU - Kumar,Suman, AU - Jain,Priyanka, AU - Kumar,Guresh, AU - Bhadoria,Ajeet Singh, AU - Moreau,Richard, AU - Kedarisetty,Chandan Kumar, AU - Abbas,Zaigham, AU - Amarapurkar,Deepak, AU - Bhardwaj,Ankit, AU - Bihari,Chhagan, AU - Butt,Amna Subhan, AU - Chan,Albert, AU - Chawla,Yogesh Kumar, AU - Chowdhury,Ashok, AU - Dhiman,RadhaKrishan, AU - Dokmeci,Abdul Kadir, AU - Ghazinyan,Hasmik, AU - Hamid,Saeed Sadiq, AU - Kim,Dong Joon, AU - Komolmit,Piyawat, AU - Lau,George K, AU - Lee,Guan Huei, AU - Lesmana,Laurentius A, AU - Jamwal,Kapil, AU - Mamun-Al-Mahtab,, AU - Mathur,Rajendra Prasad, AU - Nayak,Suman Lata, AU - Ning,Qin, AU - Pamecha,Viniyendra, AU - Alcantara-Payawal,Diana, AU - Rastogi,Archana, AU - Rahman,Salimur, AU - Rela,Mohamed, AU - Saraswat,Vivek A, AU - Shah,Samir, AU - Shiha,Gamal, AU - Sharma,Barjesh Chander, AU - Sharma,Manoj Kumar, AU - Sharma,Kapil, AU - Tan,Soek Siam, AU - Chandel,Shivendra Singh, AU - Vashishtha,Chitranshu, AU - Wani,Zeeshan A, AU - Yuen,Man-Fung, AU - Yokosuka,Osamu, AU - Duseja,Ajay, AU - Jafri,Wasim, AU - Devarbhavi,Harshad, AU - Eapen,C E, AU - Goel,Ashish, AU - Sood,Ajit, AU - Ji,Jia, AU - Duan,Z, AU - Chen,Y, AU - ,, Y1 - 2017/08/02/ PY - 2016/06/17/received PY - 2017/03/31/accepted PY - 2017/4/11/pubmed PY - 2018/6/5/medline PY - 2017/4/11/entrez KW - PIRO KW - Multiple organ failure KW - acute kidney injury KW - acute on chronic liver failure KW - liver failure SP - 1497 EP - 1507 JF - Liver international : official journal of the International Association for the Study of the Liver JO - Liver Int. VL - 37 IS - 10 N2 - BACKGROUND AND AIM: There is limited data on predictors of acute kidney injury in acute on chronic liver failure. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting acute kidney injury in a multicentric cohort of acute on chronic liver failure patients. PATIENTS AND METHODS: Data of 2360 patients from APASL-ACLF Research Consortium (AARC) was analysed. Multivariate logistic regression model (PIRO score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of acute on chronic liver failure patients (n=997). RESULTS: Factors significant for P component were serum creatinine[(≥2 mg/dL)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(<12 mg/dL,OR 1) vs (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) vs (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(<3 mmol/LOR-1) vs (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) vs (≥5 mmol/L,OR 4.34, 95% CI 1.67-11.3)] and blood urea (OR 3.73, 95% CI 2.5-5.5); for I component nephrotoxic medications (OR-9.86, 95% CI 3.2-30.8); for R component,Systemic Inflammatory Response Syndrome,(OR-2.14, 95% CI 1.4-3.3); for O component, Circulatory failure (OR-3.5, 95% CI 2.2-5.5). The PIRO score predicted acute kidney injury with C-index of 0.95 and 0.96 in the derivation and validation cohort. The increasing PIRO score was also associated with mortality (P<.001) in both the derivation and validation cohorts. CONCLUSIONS: The PIRO model identifies and stratifies acute on chronic liver failure patients at risk of developing acute kidney injury. It reliably predicts mortality in these patients, underscoring the prognostic significance of acute kidney injury in patients with acute on chronic liver failure. SN - 1478-3231 UR - https://www.unboundmedicine.com/medline/citation/28393476/Development_of_predisposition_injury_response_organ_failure_model_for_predicting_acute_kidney_injury_in_acute_on_chronic_liver_failure_ L2 - https://doi.org/10.1111/liv.13443 DB - PRIME DP - Unbound Medicine ER -