Risk factors for incidence and prognosis of acute kidney injury in hospitalized patients with chronic liver diseases

Abstract

Abstract: Objective To investigate the incidence, etiology and prognosis of acute kidney injury (AKI) in hospitalized patients with chronic liver disease, and to provide a basis for its prevention and treatment. Methods Chronic liver disease patients hospitalized in the department of infectious diseases from October to December in 2014 were enrolled. Among those patients, AKI diagnosis and staging were carried out according to kidney disease improving global outcomes(KDIGO) standard. The cross-sectional survey was conducted for analysis of the incidence, etiology, distribution characteristics, prognosis of AKI. Results A total of 322 patients with chronic liver diseases were enrolled, with the AKI incidence as 13.97% (45/322). Among the AKI patients, the ratio of male to female was 2.2∶1, with the average age of 55.22±16.04-year old. The incidence of liver cirrhosis, chronic severe hepatitis, hepatocellular carcinoma (HCC) and other chronic hepatitis were 57.77%, 24.44%, 11.11% and 6.66%, respectively. KDIGO Ⅰ,Ⅱ, Ⅲ accounted for 57.77%, 24.44%, 17.77% in all the AKI patients, 39.99%, 11.11%, 6.66% in cirrhosis, 4.44%,11.11%, 8.89% in chronic severe hepatitis, 6.67%,2.22%, 2.22% in HCC, and 6.67%, 0.0%, 0.0% in other chronic hepatitis, respectively. Additionally, on day 7 after AKI, complete renal recovery rate was 15.55%, partial renal recovery rate was 24.44% and renal loss rate was 60.00%. The mortality was 33.33% on day 28, which was 15.38 %, 54.54% and 62.50% in AKI stage Ⅰ, Ⅱ and Ⅲ, respectively. Levels of baseline serum creatinine, highest serum creatinine, model for end-stage liver disease (MELD) score, cystatin c (Cys-C) and C-reactive protein (CRP) in death group were significantly higher than those in survival group (P<0.05). Otherwise, the level of serum sodium in death group was obviously lower than that in survival group (P<0.05). Conclusion AKI is one of the most common complications in hospitalized patients with chronic liver diseases, which causes unacceptably high mortality. The poor prognosis is closely correlated with the advanced AKI stage, higher MELD score, higher CRP level and lower serum sodium concentration.

Key words: Acute kidney injury, Inpatients, Chronic liver disease, Etiology, Prognosis

SHI Dong-mei, XIANG Xiao-gang, WANG Xiao-lin, XIE Qing. Risk factors for incidence and prognosis of acute kidney injury in hospitalized patients with chronic liver diseases[J]. Chinese Hepatolgy, 2017, 22(3): 200-204.

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