Rakhi Maiwall1, Shiv Kumar Sarin1, Suman Kumar2, Priyanka Jain3, Guresh Kumar3, Ajeet Singh Bhadoria3, Richard Moreau4,5, Chandan Kumar Kedarisetty1, Zaigham Abbas6, Deepak Amarapurkar7, Ankit Bhardwaj3, Chhagan Bihari8, Amna Subhan Butt9, Albert Chan10, Yogesh Kumar Chawla11, Ashok Chowdhury1, RadhaKrishan Dhiman11, Abdul Kadir Dokmeci12, Hasmik Ghazinyan13, Saeed Sadiq Hamid9, Dong Joon Kim14, Piyawat Komolmit15, George K Lau16, Guan Huei Lee17, Laurentius A Lesmana18, Kapil Jamwal1, Rajendra Prasad Mathur19, Suman Lata Nayak19, Qin Ning20, Viniyendra Pamecha21, Diana Alcantara-Payawal22, Archana Rastogi8, Salimur Rahman23, Mohamed Rela24, Vivek A Saraswat25, Samir Shah26, Gamal Shiha27, Barjesh Chander Sharma28, Manoj Kumar Sharma1, Kapil Sharma1, Soek Siam Tan29, Shivendra Singh Chandel1, Chitranshu Vashishtha1, Zeeshan A Wani1, Man-Fung Yuen30, Osamu Yokosuka31, Ajay Duseja11, Wasim Jafri9, Harshad Devarbhavi32, C E Eapen33, Ashish Goel34, Ajit Sood35, Jia Ji36, Z Duan37, Y Chen38. 1. Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India. 2. Department of Clinical Hematology, Command Hospital [Eastern Command], Kolkata, India. 3. Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India. 4. UMR_S1149, Center for Research in Inflammation (CRI), Inserm and Paris Diderot University, Paris, France. 5. DHU Unity, Liver unit, Beaujon hospital, APHP, Clichy, France. 6. Department of Gastroenterology, Ziauddin University Hospital, Karachi, Pakistan. 7. Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research, Mumbai, India. 8. Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India. 9. Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan. 10. Department of Surgery, Division of Hepatobiliary and Pancreatic surgery, and Liver Transplantation, The University of Hong Kong, Hong Kong, China. 11. Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 12. Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey. 13. Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia. 14. Center for Liver and Digestive Diseases, Hallym University Chuncheon Sacred Heart Hospital, Gangwon-Do, Korea. 15. Department of Medicine, Division of Gastroenterology and Hepatology, Chulalongkorn University, Bangkok, Thailand. 16. Department of Hepatology, The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China. 17. Department of Medicine, National University Health System, Singapore, Singapore. 18. Division of Hepatology, University of Indonesia, Jakarta, Indonesia. 19. Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India. 20. Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 21. Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India. 22. Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines. 23. Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. 24. Institute of Liver diseases and Transplantation, Global Health city, Chennai, India. 25. Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. 26. Department of Hepatology, Global Hospitals, Mumbai, India. 27. Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt. 28. Department of Gastroenterology, GB Pant Hospital, New Delhi, India. 29. Department of Hepatology Selayang Hospital, Selangor, Malaysia. 30. Department of Medicine, The University of Hong Kong, Hong Kong, China. 31. Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan. 32. Department of Gastroenterology, St.John's Medical College and Hospital, Bangalore, India. 33. Department of Gastroenterology and Hepatology, CMC, Vellore, India. 34. Department of Gastroenterology, Rome, NY, USA. 35. Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India. 36. Department of Gastroenterology, Liver Research Center, Beijing, China. 37. Department of Gastroenterology, Nanjing First Hospital, Nanjing, China. 38. Department of Gastroenterology, East Brunswick, NJ, USA.
Abstract
BACKGROUND AND AIM: There is limited data on predictors of acute kidney injury in acute on chronic liver failure. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting acute kidney injury in a multicentric cohort of acute on chronic liver failure patients. PATIENTS AND METHODS: Data of 2360 patients from APASL-ACLF Research Consortium (AARC) was analysed. Multivariate logistic regression model (PIRO score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of acute on chronic liver failure patients (n=997). RESULTS: Factors significant for P component were serum creatinine[(≥2 mg/dL)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(<12 mg/dL,OR 1) vs (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) vs (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(<3 mmol/LOR-1) vs (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) vs (≥5 mmol/L,OR 4.34, 95% CI 1.67-11.3)] and blood urea (OR 3.73, 95% CI 2.5-5.5); for I component nephrotoxic medications (OR-9.86, 95% CI 3.2-30.8); for R component,Systemic Inflammatory Response Syndrome,(OR-2.14, 95% CI 1.4-3.3); for O component, Circulatory failure (OR-3.5, 95% CI 2.2-5.5). The PIRO score predicted acute kidney injury with C-index of 0.95 and 0.96 in the derivation and validation cohort. The increasing PIRO score was also associated with mortality (P<.001) in both the derivation and validation cohorts. CONCLUSIONS: The PIRO model identifies and stratifies acute on chronic liver failure patients at risk of developing acute kidney injury. It reliably predicts mortality in these patients, underscoring the prognostic significance of acute kidney injury in patients with acute on chronic liver failure.
BACKGROUND AND AIM: There is limited data on predictors of acute kidney injury in acute on chronic liver failure. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting acute kidney injury in a multicentric cohort of acute on chronic liver failurepatients. PATIENTS AND METHODS: Data of 2360 patients from APASL-ACLF Research Consortium (AARC) was analysed. Multivariate logistic regression model (PIRO score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of acute on chronic liver failurepatients (n=997). RESULTS: Factors significant for P component were serum creatinine[(≥2 mg/dL)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(<12 mg/dL,OR 1) vs (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) vs (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(<3 mmol/LOR-1) vs (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) vs (≥5 mmol/L,OR 4.34, 95% CI 1.67-11.3)] and blood urea (OR 3.73, 95% CI 2.5-5.5); for I component nephrotoxic medications (OR-9.86, 95% CI 3.2-30.8); for R component,Systemic Inflammatory Response Syndrome,(OR-2.14, 95% CI 1.4-3.3); for O component, Circulatory failure (OR-3.5, 95% CI 2.2-5.5). The PIRO score predicted acute kidney injury with C-index of 0.95 and 0.96 in the derivation and validation cohort. The increasing PIRO score was also associated with mortality (P<.001) in both the derivation and validation cohorts. CONCLUSIONS: The PIRO model identifies and stratifies acute on chronic liver failurepatients at risk of developing acute kidney injury. It reliably predicts mortality in these patients, underscoring the prognostic significance of acute kidney injury in patients with acute on chronic liver failure.
Authors: Marie Griemsmann; Tammo L Tergast; Nicolas Simon; Abdul-Rahman Kabbani; Michael P Manns; Heiner Wedemeyer; Markus Cornberg; Benjamin Maasoumy Journal: Sci Rep Date: 2022-02-28 Impact factor: 4.996