Table of Content

15 March 2017, Volume 22 Issue 3

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Original Articles

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

SHI Dong-mei, XIANG Xiao-gang, WANG Xiao-lin, XIE Qing

2017, 22(3):  200-204. 

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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.

Prognostic value of combined serum cystatin C and total bilirubin in patients with acute-on-chronic liver failure

LU Meng-meng,ZHOU Xin-min

2017, 22(3):  205-209. 

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Objective To investigate the prognostic value of combined serum cystatin C (CysC) and total bilirubin (TBil) for patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods In the retrospective analysis, 162 patients with HBV-ACLF admitted in our hospital from January 2012 to January 2016 were enrolled. Baseline clinical information, laboratory examination results, Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score were collected within 24 h after admission. All patients were followed up for 90 days and divided into survival and death groups according to prognoses. Multivariate logistic regression analysis was applied to identify independent risk factors. Results Seventy-eight (48.2%) patients died during the 90-day follow-up. Serum CysC and TBil were independent predictors for mortality (P<0.01). Additionally, serum CysC was positively correlated with serum creatinine (Cr) (r=0.400, P<0.001) and MELD score (r=0.416, P<0.001), respectively. In the combination prognostic model (PM) of serum CysC and TBil, area under the receiver operating characteristic curve was 0.833, suggesting that PM had a higher predictive value than CTP and MELD score for 90-day mortality in HBV-ACLF patients. The survival rate in high risk group (PM ≥ 3.07) was 23.8%, which was markedly lower than that in low risk group (PM<3.07) (79.3%, P<0.001). Conclusion The combination prognostic model of CysC and TBil is superior to the only CTP score or MELD score in predicting 90-day mortality for HBV-ACLF patients.

Predictive value of MELD score combined with serum procalcitonin on the short-term prognosis in patients with HBV-related acute-on-chronic liver failure

LI Hua

2017, 22(3):  210-213. 

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Objective To investigate the predictive value of combined model for end-stage liver disease (MELD) score and serum procalcitonin (PCT) on the short-term prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). Methods A total of 331 HBV-related ACLF patients from January 2012 to December 2015 in our hospital were respectively analyzed, and divided into survival group (208 cases) and death group (123 cases) according to the prognosis by 3-month follow-up. Serum total bilirubin (TBil), creatinine (Cr), international normalized ratio (INR), serum PCT and MELD score were measured and compared between the two groups. The capability of MELD score combined with serum PCT was evaluated for predicting the short-term prognosis of HBV-related ACLF patients by receiver operating characteristic (ROC) curve. Results In death group, serum levels of TBIL (330.9±81.9 vs 245.5±67.7 μmol/L), Cr (94.9±23.8 vs 71.2±29.3 μmol/L), PCT (1.3±0.3 vs 0.5±0.2 μg/L), INR (2.5±1.0 vs 2.1±0.6) and MELD score (26.2±6.5 vs 22.0±5.8) were significantly higher than those in the survival group, while the serum level of Na+ (128.9±14.1 vs 133.8±9.3 mmol/L) was significantly lower (all P＜0.001). The optimal cut-off value of MELD score and serum level of PCT in predicting short-term mortality were 24.8 and 0.65 μg/L. The area under the ROC (AUC) of combined MELD score and PCT (0.880) was higher than that of only MELD score (0.820) or PCT (0.803), respectively (both P＜0.001). Conclusion MELD score combined with serum PCT achieves a predictive value for the short-term prognosis in patients with HBV-related ACLF.

Treatment response of glucocorticoid in severe drug-induced liver injury

ZHANG Yu-guo, ZHAO Su-xian, LI Wen-cong, ZHANG Qing-shan, DU Hui-juan, NAN Yue-min

2017, 22(3):  214-218. 

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Objective To investigate the efficacy and safety of glucocorticoid in treatment of severe drug-induced liver injury (DILI). Methods Thirty-seven patients with severe DILI were divided into control group (n=21) and glucocorticoid group (n=16), who received only conventional therapy and conventional therapy plus small dose of glucocorticoid in short course, respectively. Results In glucocorticoid group, levels of alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TBil), direct bilirubin (DB) and alkaline phosphatase (ALP) were significantly decreased at week 2 (93.2±65.6; 61.7±30.7; 168.3±98.9; 124.7±81.4; 117.2±40.1) and week 4 (52.6±32.0; 77.4±144.1; 88.9±59.7; 64.7±48.4; 116.6±63.1) after treatment compared to those in baseline (172.9±104.8; 264.7±169.7; 259.1±108.8; 182.2±82.4; 153.8±69.9), respectively (P<0.05). In control group, ALT and AST levels were significantly lower at week 2 (P<0.05), and the serum levels of TB and DB decreased significantly at week 4 (P<0.05). The efficiency and effectiveness of treatment in glucocorticoid group were significantly higher than those in control group (93.8% vs 66.7%, χ²=11.919, P=0.001; 87.5% vs 57.1%, χ²=6.081, P=0.014). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Early medication of small dose glucocorticoid with short course might be effective and safe for severe DILI.

Effect of nonalcoholic fatty liver disease on intestinal inflammation and permeability

ZHANG Jing-yi,LI Chun-min,TANG Ying-yue,MING Ya-nan,LIU Xiao-lin,ZENG Min-de,MAO Yi-min

2017, 22(3):  219-223. 

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Objective To investigate the effect of nonalcoholic fatty liver disease (NAFLD) on intestinal inflammation and permeability. Methods Twenty-four male rats were equally and randomly divided into control and NAFLD group, which were fed with standard diet and high fat diet for 18 weeks, respectively. The NAFLD rat model was validated by liver histological examination and further grouped by pathological examination of intestinal. Serum levels of diamine oxidase (DAO), D-lactate and endotoxin were detected to evaluate intestinal permeability by enzyme-linked immunosorbent assay. Results Histologically compared with control group, NAFLD group showed macro and micro vesicular fatty degeneration and ballooning, including 7 rats with mild inflammatory cell infiltration in the intestinal tract. By contract, no intestinal inflammation change was detected in control group. Compared with those in control group, serum levels of DAO and D-lactate increased significantly in NAFLD group (P<0.05). Among NAFLD group, the rats with intestinal inflammation showed higher level of D-lactate than that without intestinal inflammation (P<0.05). Furthermore, the plasma lipopolysaccharide-binding protein (LBP) level in NAFLD group with intestinal inflammation was significantly higher than that in control group or NAFLD group without intestinal inflammation (both P<0.05), respectively. Conclusion NAFLD might increase the risk of intestinal inflammation and enhance the intestinal permeability.