Nguyen Nghia N, Nguyen Bao T, Nguyen Thuy D T, Tran Tam T T, Mai Tan N H, Le Huyen N T, Dang Hoang N, Nguyen Vy B N, Ngo Nhi Y T, Vo Cuong T
Can Tho University of Medicine and Pharmacy, 179 Nguyen Van Cu Street, An Khanh Ward, Ninh Kieu District, Can Tho City, 902510, Vietnam.
Hoan My Cuu Long Hospital, 20 Vo Nguyen Giap Street, Phu Thu Ward, Cai Rang District, Can Tho City, 902510, Vietnam.
Int Urol Nephrol. 2025 Feb 15. doi: 10.1007/s11255-025-04398-1.
Acute kidney injury (AKI) is commonly encountered in patients hospitalized for decompensated cirrhosis and is associated with prolonged hospital stays, increased treatment burden, and even mortality. The present study aimed to determine the prevalence of and develop a predictive nomogram for AKI in patients with decompensated cirrhosis.
This cross-sectional, double-center study involved 544 patients hospitalized with decompensated cirrhosis. Acute kidney injury was diagnosed using American Gastroenterological Association's guidelines with one more criterion: an increase in serum creatinine ≥ 0.3 mg/dL within 48 h or an increase in serum creatinine ≥ 50% compared to baseline serum creatinine or when the urine output is reduced below 0.5 mL/kg/h for > 6 h. We used the Bayesian model averaging method find the optimal model for predicting AKI. A predictive nomogram was also developed to enable risk prediction.
The overall AKI prevalence was 26.7% (95% Confidence interval [CI] 25.7-27.7). The optimal model for predicting AKI included diuretic therapy (odds ratio [OR]: 5.55; 95%CI 3.31-9.33), infection (OR: 2.06; 95%CI 1.31-3.22), ascites (OR: 3.20; 95%CT: 1.67-6.13), Child-Pugh group C (OR: 2.91; 95%CI 1.84-4.62), serum potassium (OR per 1 mmol/L increase: 1.62; 95%CI 1.25-2.1) and serum chloride (OR per 1 mmol/L decrease: 1.03; 95%CI 1.01-1.06). The area under the receiver operating characteristic curve was 0.8, with a 95%CI ranging from 0.75 to 0.84.
Acute kidney injury was relatively common among patients hospitalized for decompensated cirrhosis. A novel nomogram-including diuretic therapy, infection, ascites, Child-Pugh group C, serum potassium and, serum chloride, was helpful for the selective screening of AKI in patients with decompensated cirrhosis.
急性肾损伤（AKI）在因失代偿期肝硬化住院的患者中很常见，并且与住院时间延长、治疗负担增加甚至死亡相关。本研究旨在确定失代偿期肝硬化患者中AKI的患病率并开发一种预测列线图。
这项横断面、双中心研究纳入了544例因失代偿期肝硬化住院的患者。急性肾损伤根据美国胃肠病学会的指南进行诊断，另外增加一条标准：48小时内血清肌酐升高≥0.3mg/dL，或与基线血清肌酐相比血清肌酐升高≥50%，或尿量减少至低于0.5mL/kg/h超过6小时。我们使用贝叶斯模型平均法找到预测AKI的最佳模型。还开发了一种预测列线图以进行风险预测。
总体AKI患病率为26.7%（95%置信区间[CI]25.7 - 27.7）。预测AKI的最佳模型包括利尿剂治疗（比值比[OR]：5.55；95%CI 3.31 - 9.33）、感染（OR：2.06；95%CI 1.31 - 3.22）、腹水（OR：3.20；95%CT：1.67 - 6.13）、Child-Pugh C级（OR：2.91；95%CI 1.84 - 4.62）、血清钾（每增加1mmol/L的OR：1.62；95%CI 1.25 - 2.1）和血清氯（每降低1mmol/L的OR：1.03；95%CI 1.01 - 1.06）。受试者工作特征曲线下面积为0.8，95%CI范围为0.75至0.84。
急性肾损伤在因失代偿期肝硬化住院的患者中相对常见。一种新的列线图——包括利尿剂治疗、感染、腹水、Child-Pugh C级、血清钾和血清氯——有助于对失代偿期肝硬化患者进行AKI的选择性筛查。
