Characteristics of acute kidney injury and its impact on outcome in patients with acute-on-chronic liver failure.
Characteristics of acute kidney injury and its impact on outcome in patients with acute-on-chronic liver failure.
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慢性肝衰竭急性肾损伤的特点及其对预后的影响
DOI：
10.1186/s12876-022-02316-8
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发表时间：
2022-05-11
影响因子：
2.4
通讯作者：
Han, Tao
中科院分区：
文献类型：
--
作者：
Huang, Yue;Cai, Junjun;Ha, Fushuang;Guo, Beichen;Xin, Shaojie;Duan, Zhongping;Han, Tao
急性肾损伤（阿基）是肝功能衰竭的常见和危及生命的并发症。本研究的目的是建立一个诺模图和在线计算器，以预测医院获得性急性肾损伤（HA-AKI）的发展，在急性慢性肝功能衰竭（ACLF）患者，这可能有助于ACLF的预后。对574例ACLF患者进行回顾性分析。根据国际腹水俱乐部（伊卡）提出的标准定义阿基，并将其分为社区获得性AKI和医院获得性阿基（CA-AKI和HA-AKI）。CA-AKI和HA-AKI之间的差异，与发展为AKI期和从阿基期恢复相关的因素。确定危险因素并绘制列线图，以预测ACLF患者HA-AKI的发病率。在574例患者中，217例（37.8%）患者发生阿基，CA-AKI和HA-AKI分别为56例（25.8%）和161例（74.2%）。多因素Logistic回归模型（KP-AKI）预测HA-AKI发生的因素为年龄、消化道出血、细菌感染、白蛋白、总胆红素、血尿素氮和凝血酶原时间。KP-AKI在内部和外部验证中的AUROC分别为0.747和0.759。在217例阿基患者中，ICA-AKI分期进展、消退和原位波动分别为81例（37.3%）、96例（44.2%）和40例（18.4%）。阿基患者的90天死亡率为55.3%，高于非AKI患者的21.6%。阿基进展患者的90天死亡率为88.9%，其次为原位波动患者40%和阿基消退患者33.3%。KP-AKI构建的诺模图可方便、准确地预测HA-AKI的发生发展，阿基可显著增加ACLF患者的90 d死亡率。中国临床试验注册中心：ChiCTR 1900021539。在线版本包含补充材料，可通过10.1186/s12876-022-02316-8获取。
Acute kidney injury (AKI) is a common and life-threatening complication of liver failure. The purpose of this study is to construct a nomogram and online calculator to predict the development of hospital-acquired acute kidney injury (HA-AKI) in patients with acute-on-chronic liver failure (ACLF), which may contribute to the prognosis of ACLF. 574 ACLF patients were evaluated retrospectively. AKI was defined by criteria proposed by International Club of Ascites (ICA) and divided into community-acquired and hospital-acquired AKI (CA-AKI and HA-AKI). The difference between CA-AKI and HA-AKI, factors associated with development into and recovered from AKI periods. The risk factors were identified and nomograms were developed to predict the morbidity of HA-AKI in patients with ACLF. Among 574 patients, 217(37.8%) patients had AKI, CA-AKI and HA-AKI were 56 (25.8%) and 161 (74.2%) respectively. The multivariate logistic regression model (KP-AKI) for predicting the occurrence of HA-AKI were age, gastrointestinal bleeding, bacterial infections, albumin, total bilirubin, blood urea nitrogen and prothrombin time. The AUROC of the KP-AKI in internal and external validations were 0.747 and 0.759, respectively. Among 217 AKI patients, 81(37.3%), 96(44.2%) and 40(18.4%) patients were with ICA-AKI stage progression, regression and fluctuated in-situ, respectively. The 90-day mortality of patients with AKI was 55.3% higher than non-AKI patients 21.6%. The 90-day mortality of patients with progression of AKI was 88.9%, followed by patients with fluctuated in-situ 40% and regression of AKI 33.3%. The nomogram constructed by KP-AKI can be conveniently and accurately in predicting the development of HA-AKI, and AKI can increase the 90-day mortality significantly in ACLF patients. Trial registration Chinese clinical trials registry: ChiCTR1900021539. The online version contains supplementary material available at 10.1186/s12876-022-02316-8.
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影响因子：
12.6
作者：
Belcher, Justin M.;Parikh, Chirag R.;Garcia-Tsao, Guadalupe
通讯作者：
Garcia-Tsao, Guadalupe
影响因子：
9.8
作者：
Patidar, Kavish R.;Shamseddeen, Hani;Orman, Eric S.
通讯作者：
Orman, Eric S.
影响因子：
25.7
作者：
Tonon, Marta;Rosi, Silvia;Angeli, Paolo
通讯作者：
Angeli, Paolo
DOI：
10.1159/000313775
发表时间：
2010-01-01
期刊：
CARDIORENAL SYNDROMES IN CRITICAL CARE
影响因子：
--
作者：
Uchino, Shigehiko
通讯作者：
Uchino, Shigehiko
影响因子：
25.7
作者：
Piano, Salvatore;Rosi, Silvia;Angeli, Paolo
通讯作者：
Angeli, Paolo