ABSTRACT
ObjectiveTo investigate the value of combined determination of Model for End-Stage Liver Disease （MELD） score， albumin-bilirubin （ALBI） score， and β2-microglobulin in the diagnosis of liver cirrhosis with acute kidney injury （AKI）. MethodsClinical data were collected from 258 patients with liver cirrhosis who attended The First Affiliated Hospital of Zhengzhou University from October 2019 to October 2022， and according to the presence or absence of AKI， they were divided into AKI group with 117 patients and non-AKI group with 141 patients. The changes in each index were compared between the two groups and between the patients with different stages of kidney injury. The independent samples t-test was used for comparison of normally distributed continuous data between two groups， and a one-way analysis of variance was used for comparison between multiple groups； the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Kruskal-Wallis H test was used for comparison between multiple groups； the chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic （ROC） curve was plotted to evaluate the efficacy of each index in the diagnosis of liver cirrhosis with AKI. ResultsCompared with the non-AKI group， the AKI group had significantly higher age （t=2.307， P=0.022）， proportion of patients with hepatic encephalopathy （χ2=18.064， P<0.001） or with spontaneous peritonitis （χ2=16.397， P<0.001）， mortality rate （χ2=45.251， P<0.001）， levels of creatinine （Z=-8.737， P<0.001） and β2-microglobulin （Z=-8.829， P<0.001）， and scores of CTP （Z=-4.058， P<0.001）， ALBI （t=2.563， P=0.011）， and MELD （Z=-5.628， P<0.001）， as well as a significantly shorter length of hospital stay （Z=-3.391， P=0.001）. There were significant differences in creatinine， β2-microglobulin， MELD score， and ALBI score between the patients with stage 1， 2 or 3 AKI （P<0.05）， while there was no significant difference in CTP score between these three groups （P>0.05）. The combined determination of ALBI score， MELD score， and β2-microglobulin had an area under the ROC curve （AUC） of 0.837 （95% confidence interval ［CI］： 0.782 — 0.892）， with a sensitivity of 75.2% and a specificity of 90.8%； ALBI score combined with MELD score had an AUC of 0.700 （95%CI： 0.636 — 0.764）， ALBI score combined with β2 microglobulin had an AUC of 0.823 （95%CI： 0.765 — 0.881）， and MELD combined with and β2 microglobulin had an AUC of 0.835 （95%CI： 0.779 — 0.890）， suggesting that combined determination of ALBI score， MELD score， and β2-microglobulin had a better diagnostic efficacy than ALBI score， MELD score， or β2-microglobulin used alone or in pairs， as well as a better diagnostic efficacy than creatinine. ConclusionCombined determination of ALBI score， MELD score， and β2-microglobulin has a relatively high value in the diagnosis of liver cirrhosis with AKI.