ABSTRACT
Objective To investigate the incidence and risk factors of acute kidney injury (AKI)in hepatitis B virus (HBV)related acute-on-chronic liver failure (ACLF)patients,and to explore the impact of AKI on the prognosis of ACLF.Methods The medical records of 227 patients who were diagnosed with HBV-related ACLF at the Department of Infectious Diseases in the First Affiliated Hospital of Nanchang University from January 2015 to August 2016 were retrospectively reviewed.Patients were divided into AKI group and non-AKI group based on the AKI criteria published by International Club of Ascites in 2015 .Demographic and clinical data were compared between groups.The AKI incidence and its impact on patients’prognosis were analyzed.The comparison of continuous variables was done by t test or rank-sum test.The comparison of categorical variables was done byχ2 test or Fisher exact test.AKI risk factors were analyzed by using logistic regression.Results There were 66 (29.1 %)cases were diagnosed with AKI among 227 ACLF patients,among which,45 patients (68.2%)were stage Ⅰ,14 (21 .2%) were stage Ⅱ and 7 (10.6%)were stage Ⅲ.Age,cirrhosis,concentrations of total bilirubin and albumin,international normalized ratio (INR),percentage of neutrophils,MELD scores and spontaneous peritonitis rate (SBP)were all statistically different between AKI group and non-AKI group (all P <0.05).The binary logistic regression analysis revealed that only INR (OR=3.132,P =0.001 )and SBP (OR=4.204,P =0.001 )were the independent risk factors of AKI.The optimal cut-off value for INR was 2.025 with AUROC of 0.609 (P =0.01),sensitivity of 59.1 % and specificity of 62.1 %.The 30-day mortality of AKI group was significantly higher than non-AKI group (χ2= 18.324,P < 0.01). Conclusions AKI is relatively common in patients with ACLF.The risk factors of AKI are INR and SBP. AKI has significant impact on the short-term survival rate of ACLF.Therefore,physicians should pay attention to patients with INR of ACLF at admissions and SBP during the management so as to prevent the occurrence of AKI and to reduce the fatality of ACLF.
ABSTRACT
Acute-on-chronic liver failure (ACLF) is the most common type of liver failure in China, and it has complicated clinical manifestations and high mortality. When the patients experience ACLF complicated by acute kidney injury (AKI), they tend to have a prolonged length of hospital stay and a high risk of multiple organ failure, which always suggests poor prognosis. This article briefly describes the advances in the definition, causative factors, prognostic evaluation, diagnostic markers, and treatment of ACLF complicated by AKI. It is pointed out that early identification, diagnosis, and intervention of AKI helps to reverse kidney injury and avoid the development of severe AKI.
ABSTRACT
Objectives To evaluate the effectiveness of ARB in antihypertensive therapy and judge whether it can also protect cardiovascular. Methods A randomized double-blinded placebo-controlled study was used to survey over ten thousand patients in ARB clinical practices. The primary endpoint was stroke, acute myocardial infarction, heart failure, deadly cardiovascular diseases, total mortal. The results were given comprehensive analysis and statistical processing. Results In LIFE study, ARB was more effective than ?-blockers and ARB had the role of protecting the cardiovascular besides lowering the blood pressure. But the VALUE study showed that ARB was not more effective than Besylate. Conclusion There is no obvious distinction between ARB and the other drugs in reducing the blood pressure.