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Objective:To analyze the predictive ability of model for end-stage liver disease (MELD)-sarcopenia score in short-term prognosis of patients with acute-on-chronic liver failure (ACLF).Methods:Two hundred and seventy-one patients with ACLF hospitalized in Tianjin Third Central Hospital from January 2013 to December 2019 were selected, among whom 157 cases with sarcopenia and 114 cases without sarcopenia.According to ACLF classification, the patients were divided into group A (no cirrhosis basis) of 61 cases, group B (compensated cirrhosis basis) of 99 cases, and group C (previous history of uncompensated cirrhosis) of 111 cases.The basic data, laboratory examination results, computed tomography (CT) examination results and prognosis of the patients were retrospectively collected, and the MELD score, MELD-Na score and MELD-sarcopenia score were calculated. Multivariate logistic regression, multivariate Cox proportional hazards regression, Kaplan-Meier method, log-rank method and area under receiver operating characteristic curve were used for statistical analysis.Results:Low body mass index (odds ratio ( OR)=0.93, P<0.001), complicated cirrhosis ( OR=1.14, P=0.004), complicated hepatic encephalopathy ( OR=1.31, P<0.001), high white blood cell level ( OR=1.18, P=0.009) and high platelet level ( OR=1.08, P<0.001) were independent risk factors for sarcopenia in patients with ACLF. High MELD score (hazard ratio ( HR)=1.02, P=0.001), high MELD-Na score ( HR=1.07, P=0.038), high MELD-sarcopenia score ( HR=1.14, P<0.001), high total bilirubin ( HR=1.00, P<0.001) and high international normalized ratio (INR) ( HR=1.71, P<0.001) were independent risk factors for death in patients with ACLF. In subgroup analysis, the cumulative survival rate of sarcopenia patients in group A and B was lower than that of non-sarcopenia patients ( χ2=5.97 and 8.34, respectively, P=0.015 and 0.004, respectively), while there was no significant difference in the cumulative survival rate between sarcopenia patients and non-sarcopenia patients in group C ( χ2=4.90, P=0.053). In groups A and B, the area under the curve (AUC) of MELD-sarcopenia score in predicting short-term prognosis was 0.87, which was higher than MELD score (0.78) and MELD-Na score (0.78), and the differences were both statistically significant ( Z=2.86 and 2.56, respectively, P=0.004 and 0.011, respectively). The AUC of MELD-Na score in predicting short-term prognosis in group C (0.83) was higher than that of MELD score (0.71) and MELD-sarcopenia score (0.69), and the differences were both statistically significant ( Z=2.52 and 2.64, respectively, P=0.012 and 0.008, respectively). Conclusions:Patients with ACLF with no cirrhosis basis or compensated cirrhosis basis complicated with sarcopenia have shorter survival time and worse prognosis than those without sarcopenia. For patients with ACLF with no cirrhosis basis or compensated cirrhosis basis, MELD-sarcopenia score has better predictive value for the short-term prognosis.
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Objective:To investigate the clinical characteristics and risk factors for the progression of acute-on-chronic liver failure(ACLF)associated with hepatitis B in elderly patients.Methods:A total of 168 elderly patients with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)at Tianjin Third Central Hospital who met the diagnostic criteria of the Asian Pacific Association for the Study of the Liver(APASL)-ACLF were enrolled, 176 non-elderly HBV-ACLF patients served as the control group during the same period, and their baseline and progression data were recorded.At the same time, the elderly group was divided into the progressive subgroup and the non-progressive subgroup based on the diagnostic criteria of the European Society for the Study of the Liver(EASL)-ACLF, and their baseline and progression data were recorded.Independent risk factors for HBV-ACLF progression in the elderly were analyzed using multivariate Cox proportional risk model regression.Results:Compared with non-elderly patients with HBV-ACLF, elderly patients were more likely to progress to meet the EASL-ACLF diagnostic criteria and have higher mortality.Multivariate Cox proportional risk model regression analysis showed that baseline arterial lactic acid levels( HR=1.77, 95% CI: 1.36-2.30, P<0.01), secondary nosocomial infections( HR=13.90, 95% CI: 3.73-51.87, P<0.01), rates of change in maximum total bilirubin( HR=1.08, 95% CI: 1.01-1.15, P=0.04), rates of change in maximum MELD( HR=4.06, 95% CI: 1.53-10.77, P=0.01)and rates of change in maximum CLIF-SOFA( HR=12.74, 95% CI: 2.46-66.08, P<0.01)were independent risk factors for progression of HBV-ACLF in elderly patients. Conclusions:Compared with non-elderly patients, elderly patients with HBV-ACLF have more advanced disease and higher mortality.Therefore, risk factors should be identified as soon as possible and treatment plans should be formulated as soon as possible to further reduce the mortality.
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Objective@#To determine the diagnostic value of serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with liver cirrhosis.@*Methods@#Serum Cys C levels in 150 liver cirrhosis patients (88 AKI and 62 non-AKI patients) were measured by the Particle-Enhanced Nephelometric Immuno-Assay. The accuracy of serum Cys C for the diagnosis of AKI in liver cirrhosis was evaluated by the ROC curve.@*Results@#Liver cirrhosis patients with AKI had significantly higher serum Cys C levels [2.37 (1.75-2.83) mg/L] than those without AKI [0.97 (0.85-1.09) g/L] (P <0.001). Serum Cys C level was highest in the acute tubular necrosis group [5.41 (2.77-6.19) mg/L], followed by the hepatorenal syndrome group [2.55 (2.28-3.59) mg/L] and prerenal azotemia group [2.07 (1.70-2.41) mg/L], and the serum Cys C level was significantly different between the three groups (P <0.001). In addition, patients with AKI were further divided into infection group and non-infection group. Serum Cys C level was significantly higher in the infection group than in the non-infection group (P <0.05). The area under the ROC curve of serum Cys C for the diagnosis of AKI in liver cirrhosis was 0.99 (0.98-1.00) at a cut-off value of 1.36 mg/L, and the sensitivity and specificity were 97% and 95%, respectively.@*Conclusion@#Serum Cys C is a good marker for detecting AKI in liver cirrhosis, and the different levels of increase in Cys C may be useful in differentiating the different types of AKI.
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<p><b>OBJECTIVE</b>To compare the acute kidney injury classification systems of RIFLE,AKIN,KDIGO and conventional criteria for determining prognosis of acute-on-chronic liver failure (ACLF) patients.</p><p><b>METHODS</b>Patients with ACLF admitted to our hospital between July 2008 and March 2014 were enrolled in the study. The incidence, stages, and outcomes of acute kidney injury were determined according to the RIFLE, AKIN,KDIGO and conventional criteria.ROC curves were generated to compare the predictive ability for 30-day mortality of the four systems.Chi-square test and Fisher's exact test were used for statistical analyses, as well.</p><p><b>RESULTS</b>All four classification systems detected acute kidney injury among the patients in the study population (n =358), but the detection rates were not consistent (expressed as % of total): KDIGO criteria: 45.0%, AKIN: 38.8%, rIFLE: 35.5%, conventional criterion: 20.4%. The KDIGO and AKIN criteria showed higher sensitivity (72%), especially to early kidney injury, but the conventional criterion showed higher specificity (92%). The AUC for 30-day mortality was highest for the conventional criteria (0.75), followed by AKIN (0.72), rIFLE (0.70) and KDIGO (0.69) (all, P less than 0.05). In-hospital mortality increased with severity of AKI in a stepwise manner.</p><p><b>CONCLUSION</b>Among the four common evaluation systems for acute kidney injury, the conventional criteria has the highest specificity for predicting short-term prognosis of patients with ACLF, while the AKIN and KDIGO criteria have the highest sensitivity for the presence of acute kidney injury, especially at the early stage.</p>
Subject(s)
Humans , Acute Kidney Injury , Classification , Diagnosis , Acute-On-Chronic Liver Failure , Diagnosis , Hospital Mortality , Incidence , Prognosis , ROC Curve , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Acute kidney injury is a common complication in patients with cirrhosis.It is characterized by a sudden drop in glomerular filtra-tion rate,retention of metabolic waste products,water-electrolyte imbalance,and acid-base disturbance.It markedly increases mortality in cirrhotic patients.Therefore,early diagnosis and treatment of acute kidney injury are essential to reduce mortality and improve prognosis. The development of the diagnostic criteria for acute kidney injury,the clinical application of new biomarkers of renal function such as cystatin C,kidney injury molecule-1 ,and neutrophil gelatinase-associated lipocalin,and the management of acute kidney injury in cirrhotic pa-tients are reviewed.Although creatinine test and monitoring of urinary output have their disadvantages,they remain the main diagnostic crite-ria for acute kidney injury.Development of new biomarkers for clinical use and elucidation of the underlying mechanisms of acute kidney in-jury have become a hotspot of basic and clinical research.