Khatua Chitta Ranjan, Panigrahi Subhendu, Mishra Debakanta, Pradhan Subhasis, Sahu Saroj Kanta, Barik Rakesh Kumar, Parida Prasanta Kumar, Behera Sambit, Parida Suryakanta, Singh Shivaram Prasad
Sriram Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India.
J Clin Transl Hepatol. 2018 Dec 28;6(4):396-401. doi: 10.14218/JCTH.2018.00035. Epub 2018 Dec 3.
Acute kidney injury (AKI) occurs commonly in patients with acute-on-chronic liver failure (ACLF). However, there are scant data regarding the impact of AKI on survival in ACLF. We performed a prospective study to evaluate the impact of AKI on survival in ACLF. This study was conducted in ACLF patients hospitalized in the Gastroenterology Department of Sriram Chandra Bhanja Medical College (India) between October 2016 and February 2018. Demographic, clinical and laboratory parameters were recorded, and outcomes were compared between patients with and without AKI and between patients with persistent AKI and AKI reversal at 48 h. We screened 439 chronic liver disease patients as per the Asian Pacific Association for the Study of the Liver criteria and found that 113 (25.7%) of them had ACLF and 78 (69%) of them had AKI as per the Acute Kidney Injury Network criteria. ACLF patients with AKI had reduced 28-day survival (44.9% vs. 74.3%; = 0.004) and 90-day survival (25.6% vs. 51.4%; = 0.007), in comparison to ACLF patients without AKI. However, when comparison was made between AKI reverters and AKI persisters at 48 h, survival was comparable for both at 28 days and 90 days. Further, about one-tenth of ACLF patients with AKI died within 48 h of hospitalization. Over two-thirds of ACLF patients had AKI. Although ACLF itself is a predictor of reduced survival, a very small increase in serum creatinine further worsens survival. Importantly, AKI at admission is a better predictor of early mortality in ACLF patients since recovery from AKI at 48 h does not improve survival.
急性肾损伤（AKI）在慢性肝功能衰竭急性发作（ACLF）患者中很常见。然而，关于AKI对ACLF患者生存影响的数据却很少。我们进行了一项前瞻性研究，以评估AKI对ACLF患者生存的影响。本研究在2016年10月至2018年2月期间，于印度斯里拉姆·钱德拉·巴尼亚医学院胃肠病科住院的ACLF患者中开展。记录了人口统计学、临床和实验室参数，并比较了有和没有AKI的患者之间以及48小时时持续性AKI和AKI逆转的患者之间的结局。我们根据亚太肝脏研究协会标准筛查了439例慢性肝病患者，发现其中113例（25.7%）患有ACLF，根据急性肾损伤网络标准，其中78例（69%）患有AKI。与没有AKI的ACLF患者相比，患有AKI的ACLF患者28天生存率降低（44.9%对74.3%；P = 0.004），90天生存率降低（25.6%对51.4%；P = 0.007）。然而，当在48小时时对AKI逆转者和AKI持续者进行比较时，两者在28天和90天时的生存率相当。此外，约十分之一的患有AKI的ACLF患者在住院48小时内死亡。超过三分之二的ACLF患者患有AKI。虽然ACLF本身就是生存率降低的一个预测因素，但血清肌酐的微小升高会进一步恶化生存率。重要的是，入院时的AKI是ACLF患者早期死亡率的更好预测因素，因为48小时时从AKI恢复并不能改善生存率。
