Abstract: Objective To investigate the diagnostic efficacies of serum adrenomedullin (ADM) and urinary thromboxane B2 (TXB2) in decompensated cirrhosis patients complicated with acute renal injury (ARI). Methods 78 patients with decompensated cirrhosis admitted to Dongfeng Hospital affiliated to Hubei University of Medicine from January 2016 to December 2018 were enrolled in this study. They were divided into non-AKI group (38 cases) and AKI group (40 cases). The general clinical data and the serum ADM, serum creatinine (Scr), and urinary TXB2 levels between these two groups were compared. The correlation between ADM and TXB2 and other clinical indicators were analyzed. The risk factors of AKI in decompensated cirrhosis patients were analyzed by logistic regression. The ROC curve was used to evaluate the diagnostic efficacies of ADM and TXB2. Results There was no difference in age [(51.19±8.62) years vs (54.06±7.57) years], gender (male/female, 21/17 vs 26/14), course of disease [(6.71±1.49) years vs (6.42±0.84) years], child Pugh grade (A/B/C grade, 10/13/15 vs 3/16/21) and MELD score (5-6/7-9/ ≥10, 8/12/18 vs 10/13/17) between non AKI group and AKI Group (P>0.05). The albumin content in AKI group was lower than that in non-AKI group [(26.95±4.68)g/L vs (35.21±6.72)g/L] (P<0.05). The contents of urea nitrogen [(14.35±2.09) mmol/L vs (5.93±0.61) mmol/L], total bilirubin [(47.19±2.44) μmol/L vs (25.94±3.60)μmol/L], Scr[(125.38±14.37)μmol/L vs (72.84±4.84)μmol/L], ADM [(328.24±45.06)pg/mL vs (176.29±24.35)pg/mL], and TXB2 [(1885.40±243.51)pg/mL vs (1107.69±104.24)pg/mL] in AKI group were higher than those in non-AKI group (P<0.05). The ADM content in serum was negatively correlated with albumin (r=-0.753, P<0.05), whereas positively correlated with urea nitrogen, total bilirubin and Scr (r=0.851, 0.492, 0.695, respectively, P<0.05). The TXB2 content in urine was negatively correlated with albumin (r=-0.516, P<0.05), whereas positively correlated with urea nitrogen, total bilirubin and Scr (r=0.641, 0.430, 0.510, respectively, P<0.05). Scr (OR=2.357, 95%CI:1.247-4.457), ADM (OR=3.458, 95%CI:1.195-10.004) and urine TXB2 (OR=3.315, 95%CI:2.175-5.052) had certain value for the diagnosis of decompensated cirrhosis complicated with AKI (P<0.05). The area under ROC curve (AUC) of Scr, ADM and TXB2 in the diagnosis of decompensated cirrhosis with AKI was 0.757, 0.905 and 0.880, respectively. The sensitivity and specificity of ADM were the highest ( 85.16% and 87.19%, respectively). Conclusion The levels of serum ADM and urinary TXB2 in patients with decompensated cirrhosis complicated with AKI are higher than those in patients without AKI. Detecting serum ADM and urinary TXB2 levels is helpful for early diagnosis of AKI in patients with decompensated cirrhosis, which is worth of widely clinical application.

Key words: Serum adrenomedullin, Urine thromboxane B2, Decompensated liver cirrhosis, Acute renal injury