Mohan Pooja Basthi, Nagaraju Shankar Prasad, Musunuri Balaji, Rajpurohit Siddheesh, Bhat Ganesh, Shetty Shiran
Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Ir J Med Sci. 2024 Aug;193(4):1817-1825. doi: 10.1007/s11845-024-03663-z. Epub 2024 Mar 22.
Acute kidney injury (AKI) occurs frequently in patients with end-stage liver disease and cirrhosis and is associated with increased short-term mortality. This study aims to study the prevalence and risk factors associated with AKI development and mortality in cirrhosis of liver patients.
In the current prospective study, hospitalized patients with liver cirrhosis from October 2021 to March 2023 were recruited. Demographic, clinical, and laboratory data were collected, which included, the etiology of cirrhosis, comorbidities, severity of liver disease, and relevant biochemical parameters. The patient was followed up for 90 days to record the clinical outcome. The statistical software SPSS was utilized to conduct the analysis.
Of 364 liver cirrhosis patients, 25.2% (n, 92) had AKI and belonged to an average age of 51.54 ± 11.82 years. The majority of individuals in the study were males (90.4%), and alcohol (63.4%) was the most common etiology of liver cirrhosis. The present study showed that higher level of direct bilirubin (p = 0.011) and MELD score (p = 0.0001) were identified as significant risk factors for AKI development in patients with liver cirrhosis. Regarding mortality, the significant risk factors were the presence of AKI (p = 0.045) and MELD score (p = 0.025). Among AKI patients, 90-day mortality rates were higher in patients with acute tubular necrosis (p value = 0.010) and stage 3 AKI (p value = 0.001).
AKI is common in cirrhosis of liver patients. Elevated levels of direct bilirubin and MELD score emerged as significant factors associated with AKI development. Furthermore, AKI and MELD scores were identified as independent risk factors for mortality at both 30 and 90 days. Survival rates were influenced by both the type and stage of AKI; AKI stage 3 and ATN patients had significantly higher mortality rate. Early AKI detection and management are crucial for reducing mortality risk in liver cirrhosis patients.
急性肾损伤（AKI）在终末期肝病和肝硬化患者中频繁发生，且与短期死亡率增加相关。本研究旨在探讨肝硬化患者中AKI发生及死亡的患病率和危险因素。
在当前这项前瞻性研究中，招募了2021年10月至2023年3月期间住院的肝硬化患者。收集了人口统计学、临床和实验室数据，包括肝硬化病因、合并症、肝病严重程度及相关生化参数。对患者进行90天随访以记录临床结局。使用统计软件SPSS进行分析。
在364例肝硬化患者中，25.2%（n = 92）发生AKI，平均年龄为51.54±11.82岁。研究中的大多数个体为男性（90.4%），酒精（63.4%）是肝硬化最常见的病因。本研究表明，较高水平的直接胆红素（p = 0.011）和终末期肝病模型（MELD）评分（p = 0.0001）被确定为肝硬化患者发生AKI的显著危险因素。关于死亡率，显著危险因素为存在AKI（p = 0.045）和MELD评分（p = 0.025）。在AKI患者中，急性肾小管坏死患者（p值 = 0.010）和3期AKI患者（p值 = 0.001）的90天死亡率更高。
AKI在肝硬化患者中很常见。直接胆红素水平升高和MELD评分是与AKI发生相关的重要因素。此外，AKI和MELD评分被确定为30天和90天死亡率的独立危险因素。生存率受AKI的类型和分期影响；3期AKI和急性肾小管坏死患者的死亡率显著更高。早期检测和管理AKI对于降低肝硬化患者的死亡风险至关重要。
