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Maiwall, Rakhi;
Sarin, Shiv Kumar;
Kumar, Suman;
Jain, Priyanka;
Kumar, Guresh;
Bhadoria, Ajeet Singh;
Moreau, Richard;
Kedarisetty, Chandan Kumar;
Abbas, Zaigham;
Amarapurkar, Deepak;
Bhardwaj, Ankit;
Bihari, Chhagan;
Butt, Amna Subhan;
Chan, Albert;
Chawla, Yogesh Kumar;
Chowdhury, Ashok;
Dhiman, RadhaKrishan;
Dokmeci, Abdul Kadir;
Ghazinyan, Hasmik;
Hamid, Saeed Sadiq;
Kim, Dong Joon;
Komolmit, Piyawat;
Lau, George K.;
LEE, Guan Huei;
[...]
Development of predisposition, injury, response, organ failure model for predicting acute kidney injury in acute on chronic liver failure
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- Medientyp: E-Artikel
- Titel: Development of predisposition, injury, response, organ failure model for predicting acute kidney injury in acute on chronic liver failure
- Beteiligte: Maiwall, Rakhi; Sarin, Shiv Kumar; Kumar, Suman; Jain, Priyanka; Kumar, Guresh; Bhadoria, Ajeet Singh; Moreau, Richard; Kedarisetty, Chandan Kumar; Abbas, Zaigham; Amarapurkar, Deepak; Bhardwaj, Ankit; Bihari, Chhagan; Butt, Amna Subhan; Chan, Albert; Chawla, Yogesh Kumar; Chowdhury, Ashok; Dhiman, RadhaKrishan; Dokmeci, Abdul Kadir; Ghazinyan, Hasmik; Hamid, Saeed Sadiq; Kim, Dong Joon; Komolmit, Piyawat; Lau, George K.; LEE, Guan Huei; [...]
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Erschienen:
Wiley, 2017
- Erschienen in: Liver International
- Sprache: Englisch
- DOI: 10.1111/liv.13443
- ISSN: 1478-3223; 1478-3231
- Entstehung:
- Anmerkungen:
- Beschreibung: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background and Aim</jats:title><jats:p>There is limited data on predictors of acute kidney injury in acute on chronic liver failure. We developed a <jats:styled-content style="fixed-case">PIRO</jats:styled-content> model (Predisposition, Injury, Response, Organ failure) for predicting acute kidney injury in a multicentric cohort of acute on chronic liver failure patients.</jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p>Data of 2360 patients from <jats:styled-content style="fixed-case">APASL</jats:styled-content>‐<jats:styled-content style="fixed-case">ACLF</jats:styled-content> Research Consortium (<jats:styled-content style="fixed-case">AARC</jats:styled-content>) was analysed. Multivariate logistic regression model (<jats:styled-content style="fixed-case">PIRO</jats:styled-content> score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of acute on chronic liver failure patients (n=997).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Factors significant for P component were serum creatinine[(≥2 mg/dL)<jats:styled-content style="fixed-case">OR</jats:styled-content> 4.52, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> (3.67‐5.30)], bilirubin [(<12 mg/<jats:styled-content style="fixed-case">dL</jats:styled-content>,<jats:styled-content style="fixed-case">OR</jats:styled-content> 1) vs (12‐30 mg/<jats:styled-content style="fixed-case">dL</jats:styled-content>,<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.45, 95% 1.1‐2.63) vs (≥30 mg/<jats:styled-content style="fixed-case">dL</jats:styled-content>,<jats:styled-content style="fixed-case">OR</jats:styled-content> 2.6, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.3‐5.2)], serum potassium [(<3 mmol/<jats:styled-content style="fixed-case">LOR</jats:styled-content>‐1) vs (3‐4.9 mmol/L,<jats:styled-content style="fixed-case">OR</jats:styled-content> 2.7, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.05‐1.97) vs (≥5 mmol/L,<jats:styled-content style="fixed-case">OR</jats:styled-content> 4.34, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.67‐11.3)] and blood urea (<jats:styled-content style="fixed-case">OR</jats:styled-content> 3.73, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 2.5‐5.5); for I component nephrotoxic medications (<jats:styled-content style="fixed-case">OR</jats:styled-content>‐9.86, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 3.2‐30.8); for R component,Systemic Inflammatory Response Syndrome,(<jats:styled-content style="fixed-case">OR</jats:styled-content>‐2.14, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.4‐3.3); for O component, Circulatory failure (<jats:styled-content style="fixed-case">OR</jats:styled-content>‐3.5, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 2.2‐5.5). The <jats:styled-content style="fixed-case">PIRO</jats:styled-content> score predicted acute kidney injury with C‐index of 0.95 and 0.96 in the derivation and validation cohort. The increasing <jats:styled-content style="fixed-case">PIRO</jats:styled-content> score was also associated with mortality (<jats:italic>P</jats:italic><.001) in both the derivation and validation cohorts.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The <jats:styled-content style="fixed-case">PIRO</jats:styled-content> model identifies and stratifies acute on chronic liver failure patients at risk of developing acute kidney injury. It reliably predicts mortality in these patients, underscoring the prognostic significance of acute kidney injury in patients with acute on chronic liver failure.</jats:p></jats:sec>