Clinical Features And Short-term Prognosis Of HBV-related Cirrhotic Patients With Ascites Complicated With Acute Kidney Injury

Objective:1.To compare the clinical characteristics of HBV-related cirrhotic patients with ascites presenting with or without AKI;2.To compare the clinical features of HBV-related cirrhotic patients with ascites presenting with AKI who were stratified into 1,2 and 3 stages;3.To investigate the risk factors of short-term mortality of HBV-related cirrhotic patients with ascites presenting with AKI;4.To evaluate the clinical application of ICA-AKI criteria in HBV-related cirrhotic patients with ascites.Methods:Retrospectively collect data of 109 HBV-related cirrhotic patients with ascites who met the ICA-AKI criteria hospitalized in our hospital from January 2014 to December 2017.Another 109 patients without AKI were pair matched for age and sex,forming a control population.The clinical features and laboratory parameters were compared between the AKI group and control group.The AKI group patients were classified into 1,2,3 stages.The clinical features and laboratory parameters were compared among these three groups.Then,the AKI group patients were divided into survivor group and non-survivor group according to their outcomes.Multivariate logistic regression was performed to analyze the possible risk factors for mortality.The survival rate was calculated by Kaplan-Meier curves,the Log-rank was used to compare survival differenceResults:1.109 patients were diagnosed as AKI,with an average age of 57.50±13.0 years.83(76.1%)patients died within 7 days(3 1.2%)and 45 within 30 days(41.3%).There were significant differences in laboratory parameters,complications,MELD score and Child scores between AKI group and non-AKI group(P<0.05).2.The average Model for end-stage liver disease score of AKI-3 stage was 32.67±18.84>31.07±10.65 in stage>25.99±10.46 in stage 1(P=0.012),with significant statistical difference.there was no statistical difference in terms of complications except the degree of ascites,(P=0.023).There were significant differences in the SCr value and the time when AKI developed among the three groups,but there were no significant differences in the baseline SCr and prognosis of short-term mortality,P>0.05.3.The independent risk factors affecting the 7-day mortality of HBV-related cirrhotic patients with ascites complicated with AKI was Child score(OR=1.442,95%CI:1.150-1.808),with an AUC value of 0.789,the critical value was 10.5,the sensitivity was 0.618,and the specificity was 0.827.The independent risk factors affecting 30-day mortality was Child score(OR=1.511,95%Cl:1.204-1.896).AUC=0.812,the critical value was 9.5,the sensitivity was 0.778 and the specificity was 62.7%.4.The Kaplan-Meier curves showed a significant difference in 30-day survival rate between AKI-1 and AKI-2 stage patients,65.8%vs.38.1%(P=0.011);AKI-2 and AKI-3 stage patients,AKI-1 and AKI-3 stage patients had no significant difference,38.1%vs.50.0%(P=0.635);65.8%vs.50.0%(P=0.169),respectively.However,the survival curves among three groups present no significant difference when we separately drew the Kaplan-Meier curves for the patients who had AKI before and after the 9th day of hospitalization.Conclusions:1.The composition of the study subjects is quite different from researches of Western countries,and the overall mortality rate is higher than reported before.2.Child score is an independent risk factor for the short-term survival of HBV-related adult patients with cirrhosis and ascites presenting with AKI.3.The new ICA-AKI standard is not suitable for the diagnosis and staging of HB V-related adult patients with cirrhosis and ascites presenting with AKI.