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Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis.
World J Gastroenterol 2018; 24(21):2300-2310WJ

Abstract

AIM

To evaluate the differences in acute kidney injury (AKI) between acute-on-chronic liver failure (ACLF) and decompensated cirrhosis (DC) patients.

METHODS

During the period from December 2015 to July 2017, 280 patients with hepatitis B virus (HBV)-related ACLF (HBV-ACLF) and 132 patients with HBV-related DC (HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), liver-type fatty acid binding protein (L-FABP), cystatin C (CysC), and kidney injury molecule-1 (KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment.

RESULTS

AKI occurred in 71 and 28 of HBV-ACLF and HBV-DC patients, respectively (25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary biomarkers (NGAL, CysC, L-FABP, IL-18) were significantly elevated in patients with HBV-ACLF and AKI (ACLF-AKI), compared with that in patients with HBV-DC and AKI (DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients (49.3% vs 17.9%, P = 0.013). Forty-three patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLF-AKI patients was significantly lower than that of patients with DC-AKI (32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups (P < 0.001).

CONCLUSION

AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients.

Authors+Show Affiliations

Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China. qning@vip.sina.com.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29881239

Citation

Jiang, Qun-Qun, et al. "Acute Kidney Injury in Acute-on-chronic Liver Failure Is Different From in Decompensated Cirrhosis." World Journal of Gastroenterology, vol. 24, no. 21, 2018, pp. 2300-2310.
Jiang QQ, Han MF, Ma K, et al. Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis. World J Gastroenterol. 2018;24(21):2300-2310.
Jiang, Q. Q., Han, M. F., Ma, K., Chen, G., Wan, X. Y., Kilonzo, S. B., ... Ning, Q. (2018). Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis. World Journal of Gastroenterology, 24(21), pp. 2300-2310. doi:10.3748/wjg.v24.i21.2300.
Jiang QQ, et al. Acute Kidney Injury in Acute-on-chronic Liver Failure Is Different From in Decompensated Cirrhosis. World J Gastroenterol. 2018 Jun 7;24(21):2300-2310. PubMed PMID: 29881239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis. AU - Jiang,Qun-Qun, AU - Han,Mei-Fang, AU - Ma,Ke, AU - Chen,Guang, AU - Wan,Xiao-Yang, AU - Kilonzo,Semvua Bukheti, AU - Wu,Wen-Yu, AU - Wang,Yong-Li, AU - You,Jie, AU - Ning,Qin, PY - 2018/03/27/received PY - 2018/04/28/revised PY - 2018/05/06/accepted PY - 2018/6/9/entrez PY - 2018/6/9/pubmed PY - 2018/10/26/medline KW - Acute kidney injury KW - Acute-on-chronic liver failure KW - Biomarker KW - Decompensated cirrhosis KW - Etiology KW - Prognosis KW - Treatment SP - 2300 EP - 2310 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 24 IS - 21 N2 - AIM: To evaluate the differences in acute kidney injury (AKI) between acute-on-chronic liver failure (ACLF) and decompensated cirrhosis (DC) patients. METHODS: During the period from December 2015 to July 2017, 280 patients with hepatitis B virus (HBV)-related ACLF (HBV-ACLF) and 132 patients with HBV-related DC (HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), liver-type fatty acid binding protein (L-FABP), cystatin C (CysC), and kidney injury molecule-1 (KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment. RESULTS: AKI occurred in 71 and 28 of HBV-ACLF and HBV-DC patients, respectively (25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary biomarkers (NGAL, CysC, L-FABP, IL-18) were significantly elevated in patients with HBV-ACLF and AKI (ACLF-AKI), compared with that in patients with HBV-DC and AKI (DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients (49.3% vs 17.9%, P = 0.013). Forty-three patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLF-AKI patients was significantly lower than that of patients with DC-AKI (32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups (P < 0.001). CONCLUSION: AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/29881239/Acute_kidney_injury_in_acute_on_chronic_liver_failure_is_different_from_in_decompensated_cirrhosis_ L2 - http://www.wjgnet.com/1007-9327/full/v24/i21/2300.htm DB - PRIME DP - Unbound Medicine ER -