Prospective study on the risk factors and the treatment response of acute renal injury in liver cirrhotic patients

Abstract

Abstract: Objective To prospectively observe the risk of morbidity and the therapeutic effect of acute kidney injury in patients with cirrhosis based on 2015 International Ascites Club (IAC) diagnostic criteria. Methods A prospective, observational and open method was used to observe the hospitalized patients with decompensated cirrhosis. Once acute kidney injury (AKI) occurred, the patients were diagnosed and treated according to the new ICA-AKI guideline. Data were collected during the treatment period to evaluate the therapeutic response. The risk factors for AKI complication and the influencing factors for the treatment were analyzed by logistic regression. Results A total of 804 patients with decompensated cirrhosis were included in the study. 213 patients(26.5%, 213/804) were complicated with AKI during hospitalization or had AKI at admission, of which 68.1%(145/213)、25.3%(54/213)and 6.6%(14/213)were AKI stage 1, 2 and 3, respectively. The 2015 dagnostic criteria of HRS was shown to improve the diagnostic sensitivity. A missed diagnosis rate of 20.9%(14/67)were found in these patients if using the 2007 standard. Multivariate analysis showed that age, MELD score (P=0.004), infection(P=0.000) and upper gastrointestinal bleeding (P=0.000)were the main risk factors of AKI in decompensated cirrhotic patients. After personalized treatment according to AKI stage, 86.9% (185/213) of the patients with AKI were improved. Multivariate analysis showed that only the preliminary stage of AKI was the main factor affecting the prognosis of the AKI patients (P=0.000). If the initial AKI stage increased, the proportion of responsive treatment decreased. The treatment responsive rate in AKI stages 1, 2 and 3 were 94.5% (137/145), 70.4% (38/54) and 28.6% (4/14), respectively. Conclusion The updated diagnostic and management procedure by ICA improves the diagnostic sensitivity and treatment responsive rate of AKI in decompensated cirrhotic patients, This enables some previously neglected patients to be treated timely. By using the new guideline a higher responsive rate can be achieved but the intervention is required to initiate at a lower AKI stage.

Key words: Acute kidney injury, Liver cirrhosis, Treatment response, Prospective study, Influencing factors

YIN Wei, LI Cheng-zhong. Prospective study on the risk factors and the treatment response of acute renal injury in liver cirrhotic patients[J]. Chinese Hepatolgy, 2020, 25(8): 791-796.

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