Tags

Type your tag names separated by a space and hit enter

Risk Factors and Outcomes of Acute Kidney Injury in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure.
Am J Med Sci. 2017 05; 353(5):452-458.AJ

Abstract

BACKGROUND

Acute kidney injury (AKI) is common in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF); however, few studies concerning the risk factors and recovery patterns of renal function have been published.

MATERIALS AND METHODS

A retrospective analysis of 150 patients with HBV-ACLF was performed. The occurrence, risk factors and functional recovery of AKI among patients with HBV-ACLF were investigated.

RESULTS

A total of 90 patients (60%) with HBV-ACLF developed AKI. Patients with AKI had higher creatine kinase (P = 0.004), total bilirubin (P = 0.039), HBV viral load (P = 0.044), serum creatine (P < 0.001) and model for end-stage liver disease (MELD) score (P < 0.001) values and a higher proportion of hepatic encephalopathy (P = 0.032) and spontaneous bacterial peritonitis (SBP) (P = 0.042) than patients without AKI. Logistic regression analysis illustrated that SBP (odds ratio = 6.214, P = 0.012) and MELD score (odds ratio = 1.097, P = 0.006) were risk factors for the development of AKI. A subgroup analysis of recovery patterns in renal function showed that patients with a severe AKI stage had worse outcomes (P = 0.007). The proportion of patients who experienced a complete recovery was higher in survivors than in the overall AKI populations (P = 0.004). Follow-up studies showed that the no-AKI group had a higher transplant-free survival rate than the AKI group at day 90 (80.0% versus 26.7%, respectively, P < 0.001). The survival rate among patients with AKI Stage 1 was higher than that of patients with AKI Stage 2 and patients with AKI Stage 3 (P < 0.001).

CONCLUSIONS

AKI is common in patients with HBV-ACLF. The SBP and MELD score have some prognosis value for patients with AKI. AKI and its stages affect the 90-day transplant-free mortality rate. It is important to focus on exploring the early recognition of AKI and early intervention of those risk factors in individuals with HBV-ACLF.

Authors+Show Affiliations

Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China.Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China.Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China.Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China.Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China. Electronic address: luhongzhou@fudan.edu.cn.Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, P.R. China. Electronic address: qianzhiping_shaphc@126.com.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28502331

Citation

Yuan, Wei, et al. "Risk Factors and Outcomes of Acute Kidney Injury in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure." The American Journal of the Medical Sciences, vol. 353, no. 5, 2017, pp. 452-458.
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. Am J Med Sci. 2017;353(5):452-458.
Yuan, W., Zhang, Y. Y., Zhang, Z. G., Zou, Y., Lu, H. Z., & Qian, Z. P. (2017). Risk Factors and Outcomes of Acute Kidney Injury in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure. The American Journal of the Medical Sciences, 353(5), 452-458. https://doi.org/10.1016/j.amjms.2017.03.005
Yuan W, et al. Risk Factors and Outcomes of Acute Kidney Injury in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure. Am J Med Sci. 2017;353(5):452-458. PubMed PMID: 28502331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk Factors and Outcomes of Acute Kidney Injury in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure. AU - Yuan,Wei, AU - Zhang,Yu-Yi, AU - Zhang,Zheng-Guo, AU - Zou,Ying, AU - Lu,Hong-Zhou, AU - Qian,Zhi-Ping, Y1 - 2017/03/21/ PY - 2016/11/16/received PY - 2017/01/26/revised PY - 2017/03/02/accepted PY - 2017/5/16/entrez PY - 2017/5/16/pubmed PY - 2017/6/16/medline KW - Acute kidney injury KW - Acute-on-chronic liver failure KW - Critical care outcomes KW - Prognosis KW - Risk factors SP - 452 EP - 458 JF - The American journal of the medical sciences JO - Am. J. Med. Sci. VL - 353 IS - 5 N2 - BACKGROUND: Acute kidney injury (AKI) is common in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF); however, few studies concerning the risk factors and recovery patterns of renal function have been published. MATERIALS AND METHODS: A retrospective analysis of 150 patients with HBV-ACLF was performed. The occurrence, risk factors and functional recovery of AKI among patients with HBV-ACLF were investigated. RESULTS: A total of 90 patients (60%) with HBV-ACLF developed AKI. Patients with AKI had higher creatine kinase (P = 0.004), total bilirubin (P = 0.039), HBV viral load (P = 0.044), serum creatine (P < 0.001) and model for end-stage liver disease (MELD) score (P < 0.001) values and a higher proportion of hepatic encephalopathy (P = 0.032) and spontaneous bacterial peritonitis (SBP) (P = 0.042) than patients without AKI. Logistic regression analysis illustrated that SBP (odds ratio = 6.214, P = 0.012) and MELD score (odds ratio = 1.097, P = 0.006) were risk factors for the development of AKI. A subgroup analysis of recovery patterns in renal function showed that patients with a severe AKI stage had worse outcomes (P = 0.007). The proportion of patients who experienced a complete recovery was higher in survivors than in the overall AKI populations (P = 0.004). Follow-up studies showed that the no-AKI group had a higher transplant-free survival rate than the AKI group at day 90 (80.0% versus 26.7%, respectively, P < 0.001). The survival rate among patients with AKI Stage 1 was higher than that of patients with AKI Stage 2 and patients with AKI Stage 3 (P < 0.001). CONCLUSIONS: AKI is common in patients with HBV-ACLF. The SBP and MELD score have some prognosis value for patients with AKI. AKI and its stages affect the 90-day transplant-free mortality rate. It is important to focus on exploring the early recognition of AKI and early intervention of those risk factors in individuals with HBV-ACLF. SN - 1538-2990 UR - https://www.unboundmedicine.com/medline/citation/28502331/Risk_Factors_and_Outcomes_of_Acute_Kidney_Injury_in_Patients_With_Hepatitis_B_Virus_Related_Acute_on_Chronic_Liver_Failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9629(17)30130-1 DB - PRIME DP - Unbound Medicine ER -