The Risk Factors And Predictors Of Acute Kidney Injury In Decompensated Liver Cirrhosis Patients

Objective: Liver cirrhosis(LC)combined with acute kidney injury(AKI)is one of the reasons of poor prognosis in patients with liver disease.And it’s of great significance to diagnose AKI early.When the diagnostic criteria of AKI has been updated,the changes of serum creatinine level is used to diagnose AKI in decompensated liver cirrhosis(DLC)patients now.What’s more,the increase of serum creatinine level is not clear while renal injury in the early stage,and there are some limitations in the early diagnosis of renal injury.So,it is difficult to detect renal dysfunction early in patients when doctors do clinical work.The purpose of this study was to investigate the risk factors,predictive indicators and predictive value of AKI in DLC patients complicated with AKI who were diagnosed according to the 2015 International Club Ascites(ICA)criteria.Methods: 1.The clinical data from January 2019 to December 2020 of eligible DLC patients who were hospitalized in the department of infectious diseases,the Affiliated Hospital of Southwest Medical University were collected and sorted in this retrospective study.2.DLC patients were divided into AKI group and non-AKI group according to the guidelines,to compared the clinical characteristics of those two groups by Standard t Test,χ2 test and nonparametric test Mann-Whitney U test.Then the DLC patients combined with AKI were divided into 3subgroups(AKI stage 1,AKI stage 2,AKI stage 3),and the clinical characteristics of the three subgroups were compared by Kruskal-Wallis H test(K-W H test)and χ2 test.3.We used single factor and multi-factor logistic regression analysis to study risk factors,and establish a logistic regression model(DLC-AKI-7).4.To explore the predictive value of each index and DLC-AKI-7 by Receiver Operating Characteristic Curve(ROC)in DLC patients combined with AKI.Results: 1.A total of 128 patients developed AKI among the 451 patients with DLC,the incidence rate was about 28.38%.Among them,the number of AKI stage 1 were 75 cases(58.59%),AKI stage 2 were 28cases(21.88%),AKI stage 3 were 25 cases(19.53%).2.Univariate analysis showed that acute-on-chronic liver failure,chronic liver failure,hepatic encephalopathy,infection,ascites,white blood cell count,albumin,total bilirubin,serum creatinine,glomerular filtration rate,serum potassium,serum sodium,prothrombin time,prothrombin time activity,procalcitonin,MELD-Na score,and CTP score were associated with AKI in patients with DLC,P<0.05.Multi-factor logistic regression analysis showed that hepatic encephalopathy [OR 2.766,95%CI(1.050,7.283),P<0.05],ascites [OR 2.783,95%CI(1.414,5.478),P<0.05],glomerular filtration rate [OR 0.975,95%CI(0.960,0.989),P<0.05],serum sodium [OR 0.934,95%CI(0.879,0.991),P<0.05],serum retinol-binding protein [OR 1.043,95%CI(1.012,1.076),P<0.05] and CTP score [OR 1.205,95%CI(1.021,1.422),P<0.05] were independent risk factors for the AKI in DLC.3.According to the results of multivariate analysis,a diagnostic model(DLC-AKI-7)of AKI in patients with DLC was established.The AUC of DLC-AKI-7 was 0.882,the specificity was 78.33%,and the sensitivity was 87.50%.The ROC curve showed that DLC-AKI-7(AUC 0.882,P<0.0001),serum creatinine(AUC 0.873,P<0.0001),glomerular filtration rate(AUC 0.850,P<0.0001),CTP score(AUC 0.675,P<0.0001),serum sodium(AUC0.648,P<0.0001),and serum retinol-binding protein(AUC 0.566,P=0.0327)can predict the incidence of AKI.The AUC of DLC-AKI-7and serum creatinine were compared with other indicators respectively,and the differences were statistically significant.Conclusion: 1.The incidence of AKI in patients with DLC is about28.38%,and the incidence of AKI will increase(40.98%)in patients with DLC and acute-on-chronic liver failure(ACLF)at the same time.2.Hepatic encephalopathy,ascites,the increased admission level of CTP score and serum retinol-binding protein,the decreased admission level of glomerular filtration rate and serum sodium are independent factors for AKI in patients with DLC.3.DLC-AKI-7 and the admission level of serum creatinine were good at predicting the development of AKI,the AUC(0.882)of the DLC-AKI-7 is higher,although there is no statistical difference between them.