Division of Gastroenterology, Hepatology and Nutrition.
Department of Biostatistics.
Hepatology. 2018 Jul;68(1):224-233. doi: 10.1002/hep.29772. Epub 2018 May 17.
Current approaches to determine the cause of acute kidney injury (AKI) in patients with cirrhosis are suboptimal. The aim of this study was to determine the utility of fractional excretion of urea (FEUrea) for the differential diagnosis of AKI in patients with cirrhosis. A retrospective analysis was performed in patients (n = 50) with cirrhosis and ascites admitted with AKI. Using adjudicated etiology assessment as the reference standard, receiver operating curves and optimal cutoff, sensitivity (Sn), and specificity (Sp) for the diagnosis of prerenal azotemia (PRA), type 1 hepatorenal syndrome (HRS), and acute tubular necrosis (ATN) were derived. Validation was performed in an independent cohort (n = 50) and by bootstrap analysis. The causes of AKI (derivation:validation cohorts) were: PRA 21:21, HRS 18:15, and ATN 11:14. Median FEUrea was statistically different across all etiologies of AKI in the derivation cohort (PRA 30.1 vs. HRS 20.2 vs. ATN 43.6; P < 0.001) and validation cohort (PRA 23.1 vs. HRS 13.3 vs. ATN 44.7; P < 0.001). The area underneath the curve (cutoff, Sn/Sp) for FEUrea was 0.96 (33.4, 85/100) for ATN versus non-ATN, 0.87 (28.7, 75/83) for HRS versus non-HRS, and 0.81 (21.6, 90/61) for PRA versus HRS. When applied to the validation cohort, Sn/Sp were maintained for ATN versus non-ATN (93/97), HRS versus non-HRS (100/63), and for PRA versus HRS (67/80). After bootstrapping, Sn/Sp for FEUrea in the ATN versus non-ATN, HRS versus non-HRS, and PRA versus HRS was 88/96, 63/97, and 55/87, respectively.
FEUrea is a promising tool for the differential diagnosis of AKI in patients with cirrhosis. (Hepatology 2018;68:224-233).
评估尿尿素排泄分数（FEUrea）在肝硬化伴急性肾损伤（AKI）患者中的鉴别诊断价值。
本研究对因 AKI 住院的肝硬化伴腹水患者进行了回顾性分析（n=50）。采用有定论的病因评估作为参考标准，获得了用于鉴别诊断肾前性氮质血症（PRA）、1 型肝肾综合征（HRS）和急性肾小管坏死（ATN）的受试者工作特征曲线（ROC）和最佳截断值、敏感性（Sn）和特异性（Sp）。在独立队列（n=50）中进行了验证，并通过自举分析进行了验证。AKI 的病因（推导队列验证队列）为：PRA 21 例 21 例，HRS 18 例 15 例，ATN 11 例 14 例。推导队列和验证队列中，FEUrea 在所有 AKI 病因之间均有统计学差异（PRA 30.1 比 HRS 20.2 比 ATN 43.6；P<0.001）。ROC 曲线下面积（截断值、Sn/Sp）为：ATN 对非 ATN（33.4，85/100）为 0.96，HRS 对非 HRS（28.7，75/83）为 0.87，PRA 对 HRS（21.6，90/61）为 0.81。将其应用于验证队列后，ATN 对非 ATN（93/97）、HRS 对非 HRS（100/63）和 PRA 对 HRS（67/80）的 Sn/Sp 得以维持。自举后，FEUrea 用于 ATN 对非 ATN、HRS 对非 HRS 和 PRA 对 HRS 的 Sn/Sp 分别为 88/96、63/97 和 55/87。
FEUrea 是肝硬化伴 AKI 患者鉴别诊断的一种很有前途的工具。
