Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
Department of Gastroenterology, Chuno Kosei Hospital, Gifu, Japan.
J Gastroenterol. 2024 Sep;59(9):849-857. doi: 10.1007/s00535-024-02126-7. Epub 2024 Jun 11.
Acute kidney injury (AKI) is a serious complication of cirrhosis. This study analyzed the prognostic effect of AKI in patients with cirrhosis and its risk factors, particularly in relation to amino acid imbalance.
This retrospective study reviewed 808 inpatients with cirrhosis at two institutes in Gifu, Japan. AKI was diagnosed according to the recommendations of the International Club of Ascites. Amino acid imbalance was assessed by measuring serum branched-chain amino acid (BCAA) levels, tyrosine levels, and the BCAA-to-tyrosine ratio (BTR). Factors associated with mortality and AKI development were assessed using the Cox proportional hazards regression model with AKI as a time-dependent covariate and the Fine-Gray competing risk regression model, respectively.
Of the 567 eligible patients without AKI at baseline, 27% developed AKI and 25% died during a median follow-up period of 4.7 years. Using a time-dependent covariate, AKI development (hazard ratio [HR], 6.25; 95% confidence interval [CI], 3.98-9.80; p < 0.001) was associated with mortality in patients with cirrhosis independent of potential covariates. In addition, alcohol-associated/-related liver disease, metabolic dysfunction-associated steatohepatitis, Child-Pugh score, and BTR (subdistribution HR 0.78; 95% CI 0.63-0.96; p = 0.022) were independently associated with AKI development in patients with cirrhosis. Similar results were obtained in the multivariate model that included BCAA and tyrosine levels instead of BTR.
AKI is common and associated with mortality in Japanese patients with cirrhosis. An amino acid imbalance is strongly associated with the development of AKI in patients with cirrhosis.
急性肾损伤（AKI）是肝硬化的严重并发症。本研究分析了 AKI 在肝硬化患者中的预后作用及其危险因素，特别是与氨基酸失衡的关系。
本回顾性研究分析了日本岐阜县两家医院的 808 例肝硬化住院患者。AKI 根据国际腹水俱乐部的建议进行诊断。通过测量血清支链氨基酸（BCAA）水平、酪氨酸水平和 BCAA 与酪氨酸比（BTR）来评估氨基酸失衡。使用 Cox 比例风险回归模型（将 AKI 作为时依协变量）和 Fine-Gray 竞争风险回归模型，分别评估与死亡率和 AKI 发展相关的因素。
在 567 名基线无 AKI 的合格患者中，27%发生 AKI，25%在中位随访 4.7 年内死亡。使用时依协变量，AKI 发展（风险比 [HR]，6.25；95%置信区间 [CI]，3.98-9.80；p<0.001）与肝硬化患者的死亡率相关，独立于潜在协变量。此外，酒精相关/相关肝病、代谢功能障碍相关脂肪性肝炎、Child-Pugh 评分和 BTR（亚分布 HR 0.78；95%CI 0.63-0.96；p=0.022）与肝硬化患者 AKI 发展独立相关。在包含 BCAA 和酪氨酸水平而不是 BTR 的多变量模型中也得到了类似的结果。
AKI 在日本肝硬化患者中很常见，并与死亡率相关。氨基酸失衡与肝硬化患者 AKI 的发展密切相关。
