Risk factors for progression of acute kidney injury in decompensated cirrhosis patients with acute kidney injury / 中华传染病杂志

ABSTRACT

Objective:To analyze the risk factors for the progression of acute kidney injury (AKI) in decompensated cirrhosis patients with acute kidney injury.Methods:The basic data and laboratory results of decompensated cirrhosis patients with AKI hospitalized in the Department of Infectious Diseases, The First Affiliated Hospital of Naval Medical University from May 2016 to November 2021 were collected. Treatment and intervention were performed according to the International Club of Ascites guidelines. According to the outcome of AKI during hospitalization, patients were divided into the progression group and the non-progression group. Two independent sample rank sum test, two independent sample or approximate t test, chi-square test and binary logistic regression analysis were used for statistical analysis. Results:A total of 263 decompensated cirrhosis AKI patients were enrolled, including 50 in the progressive group and 213 in the non-progressive group. Univariate analysis showed that there were statistically significant differences in baseline total bilirubin, alanine aminotransferase, prothrombin time, serum sodium, white blood cell count, model for end-stage liver disease score, proportion of patients with infection, proportion of patients with upper gastrointestinal hemorrhage, and proportion of patients with primary AKI stage between the two groups ( Z=-6.49, -3.53, t=-3.06, 3.40, -3.55, -8.19 and χ2=14.64, 8.40, 103.98, respectively, all P<0.050). Binary logistic regression analysis showed that primary AKI stage (stage two odds ratio ( OR)=33.176, 95% confidence interval ( CI) 11.294 to 97.458, P<0.001; stage three OR=114.139, 95% CI 25.321 to 514.515, P<0.001), upper gastrointestinal hemorrhage ( OR=3.850, 95% CI 1.238 to 11.971, P=0.020) and total bilirubin ( OR=1.009, 95% CI 1.005 to 1.012, P<0.001) were the risk factors for the progression of AKI in patients with decompensated cirrhosis. Conclusions:Decompensated cirrhosis patients with AKI stage two or three, high baseline total bilirubin value or gastrointestinal hemorrhage have a high risk of AKI progression. It is necessary to strengthen the assessment and take targeted intervention measures at early stage in the clinical practice.