Gupta Tarana, Ranga Naveen, Goyal Sandeep Kumar
Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India.
Independent Researcher, Kangra 176056, Himachal Pradesh, India.
World J Hepatol. 2022 Mar 27;14(3):592-601. doi: 10.4254/wjh.v14.i3.592.
Acute kidney injury (AKI) in cirrhosis is important complication with poor outcomes. And infections are common cause for acute decompensation. Infections in cirrhosis lead to acute deterioration of hemodynamics leading to precipitation of AKI.
To study predictors of mortality in patients with infection-associated AKI in cirrhosis.
This was a prospective, observational study conducted at tertiary care centre from January 2018 till April 2019. Total 119 participants with cirrhosis of liver presenting with AKI were included into the study. AKI was defined as per international club of Ascites-AKI criteria 2015. Patients were grouped into infection AKI and non-infection AKI. Non-infection AKI included patients with diuretic induced AKI and pre-renal AKI. Logistic regression analysis was used to determine predictors of mortality at 28-d.
Out of 119 patients, alcohol ( = 104) was most common etiology of cirrhosis. The infection AKI included 67 (56%) patients and non-infection AKI ( = 52) included pre-renal AKI in 36 (30%) and diuretic-induced AKI in 16 (14%) patients. Infection AKI had significantly higher bilirubin, higher international normalized ratio (INR), low serum sodium, higher total leukocyte count (TLC) and higher prevalence of hepatic encephalopathy (HE) as compared to non-infection AKI. Infection AKI had higher progression of AKI (19/67 2/52; = 0.01) and 28-d mortality (38/67 4/5; ≤ 0.01) as compared to non-infection AKI. At 28-d, non-survivors ( = 42) had significantly higher bilirubin, higher INR, low serum sodium, higher TLC and higher prevalence of HE as compared to survivors ( = 77). On subgroup analysis of Infection AKI group, on multivariate analysis, serum bilirubin as well as presence of HE were independent predictors of 28-d mortality. There was no significant difference of mortality at 90-d between two groups.
Infection AKI in cirrhosis has a dismal prognosis with higher 28-d mortality as compared to non-infection AKI. Serum bilirubin and presence of HE predict 28-d mortality in infection AKI.
肝硬化患者发生急性肾损伤（AKI）是一种重要的并发症，预后较差。感染是急性失代偿的常见原因。肝硬化患者发生感染会导致血流动力学急性恶化，进而引发AKI。
研究肝硬化合并感染相关性AKI患者的死亡预测因素。
这是一项前瞻性观察性研究，于2018年1月至2019年4月在一家三级医疗中心进行。共有119例肝硬化合并AKI的患者纳入本研究。AKI根据2015年国际腹水俱乐部 - AKI标准进行定义。患者分为感染性AKI组和非感染性AKI组。非感染性AKI包括利尿剂所致AKI和肾前性AKI患者。采用逻辑回归分析确定28天死亡率的预测因素。
119例患者中，酒精性（n = 104）是肝硬化最常见的病因。感染性AKI组有67例（56%）患者，非感染性AKI组（n = 52）包括肾前性AKI患者36例（30%）和利尿剂所致AKI患者16例（14%）。与非感染性AKI相比，感染性AKI患者的胆红素水平显著更高、国际标准化比值（INR）更高、血清钠水平更低、总白细胞计数（TLC）更高且肝性脑病（HE）患病率更高。与非感染性AKI相比，感染性AKI患者的AKI进展更严重（19/67比2/52；P = 0.01），28天死亡率更高（38/67比4/52；P≤0.01）。在28天时，与存活者（n = 77）相比，非存活者（n = 42）的胆红素水平显著更高、INR更高、血清钠水平更低、TLC更高且HE患病率更高。在感染性AKI组的亚组分析中，多因素分析显示血清胆红素以及HE的存在是28天死亡率的独立预测因素。两组90天死亡率无显著差异。
与非感染性AKI相比，肝硬化合并感染性AKI预后较差，28天死亡率更高。血清胆红素和HE的存在可预测感染性AKI患者的28天死亡率。
