Clinical features and prognosis of acute kidney injury in patients with acute on chronic liver failure associated with hepatitis B virus
10.3760/cma.j.cn112866-20210426-00069
- VernacularTitle:乙型肝炎病毒相关的慢加急性肝衰竭患者发生急性肾损伤的临床特点及预后研究
- Author:
Min CHANG
1
;
Fangfang SUN
;
Yao LU
;
Hongxiao HAO
;
Lu ZHANG
;
Ruyu LIU
;
Ge SHEN
;
Shuling WU
;
Yuanjiao GAO
;
Leiping HU
;
Minghui LI
;
Ronghai HUANG
;
Yao XIE
Author Information
1. 首都医科大学附属北京地坛医院肝病二科，北京 100015
- Keywords:
Hepatitis B virus;
Acute on chronic liver failure;
Acute kidney injury;
Prognosis
- From:
Chinese Journal of Experimental and Clinical Virology
2021;35(4):378-383
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical features and prognosis of acute kidney injury in patients with HBV related acute on chronic liver failure (ACLF).Methods:A total of 150 patients who developed acute kidney injury (AKI) in patients with HBV related ACLF from Sep. 2010 to Sep. 2019 were reviewed retrospectively, and the gender, age, laboratory examination, Child-pugh scores, and model for end-stage liver disease (MELD) were collected and the survival of the patients were followed up to analyze the prognosis.Results:Ninety-three percent of the patients were complicated with ascites, 81% with spontaneous peritonitis, 65% with hepatic encephalopathy and 58.7% with pulmonary infection; 60 patients (60.0%) were AKI stage 1, 44 patients (29.3%) were AKI stage 2, 16 patients (10.7%) were AKI stage 3. The patients with hyponatremia had lower albumin ( t=2.571, P=0.011), higher blood urea nitrogen, serum potassium and white blood cell levels than those without hyponatremia ( t=3.184, P=0.002; t=2.069, P=0.040; t=2.251, P=0.026); 74.7% of the patients died within 30 days, and the 90 days survival rate was 16.7%. The 30 days and 90 days mortality of patients with hyponatremia was higher than that of patients without hyponatremia ( χ2=4.11, P=0.044; χ2=3.901, P=0.049 7). Kaplan-Meier analysis revealed that the patients who had abnormal uric acid pre-diagnosis of AKI, hyponatremia when diagnosis of AKI, organ damage other than liver and kidney, metabolic acidosis, upper gastrointestinal tract bleeding, hepatic encephalopathy had a poor survival. Cox regression analysis showed that other organ function damage other than liver and kidney, metabolic acidosis, and the old age, were independent risk factors of death. Conclusions:Most of the AKI patients with HBV related ACLF had ascites and spontaneous bacterial peritonitis when AKI occurred, and AKI stage 1 was common. The mortality of patients with hyponatremia was high, and the risk of death was high in patients with severe organ damage other than liver and kidney, metabolic acidosis and the old age.
