Natural Course Of Acute Kidney Injury In Patients With Decompensated Cirrhosis During Hospitalization And Effect On Prognosis

Objective:1.Investigate the prevalence of AKI in decompensated cirrhosis in hospital;2.To compare the clinical indexes of patients with decompensated cirrhosis complicated with AKI in different periods;3.To explore the influencing factors of different progression pathways in the natural course of AKI and the prognosis of patients.Methods:Through the medical record management system of the First Affiliated Hospital of Nanchang University,the retrieval departments were set up in the Department of Gastroenterology and Infectious Diseases,and the admission date was January 1,2015 and December 31,2016.Patients with decompensated cirrhosis who were meeting the standards were collected.According to the new standard proposed by ICA-AKI in 2015,Clarify the disease status of AKI in patients with decompensated cirrhosis in our hospital,the clinical data of patients with AKI meeting the standard was collected,and the differences among patients with complicated AKI were compared and analyzed in different sub-periods.The natural course of AKI patients included AKI stage regression and AKI stage progression,and the differences of different outcome and their influencing factors were analyzed by grouping.Multivariate Logistic regression analysis was used to determine clinical factors related to patient outcomes.Results:According to the screening procedure,224(12.1%)of the 1858 patients with decompensated cirrhosis were diagnosed with AKI(AKI stage1 8.1%,AKI stage 22.2%,and AKI stage3 1.8%;Males accounted for 77.2%,with an average age of 53.0years;Child-Pugh mean value is 11.5;The average MELD value was 24.7),the main cause of cirrhosis was hepatitis B,accounting for 78.6%.During hospitalization,67 (29.9%)achieved AKI stage regression and 46(20.5%)AKI stage progression. Patients with stage 1 showed a better rate of improvement in AKI,higher HDL levels,and lower in-hospital mortality compared to 2/3 of patients;Patients with AKI stage progression have more severe liver damage,longer hospital stays,and lower survival.Multivariate analysis showed that: ALT>80U/L(95%CI: 0.244-0.833;P = 0.011),HDL>0.36mmol/L(95%CI: 1.053-4.251;P=0.035)was an independent influencing factor for AKI stage regression.During the hospitalization of all 224 patients,65patients(26.9%)died,and the mortality rates of patients with different stages were:AKI stage1 21.2%,AKI stage2 32.5%,and AKI stage3 60.6%(P<0.001).Multivariate analysis showed that PLT(95%CL 1.001-1.010;P=0.01),AKI improved(95%CI 0.018-0.262;P<0.001),AKI progression(95%CI 1.5544-6.514;P=0.002)was independently associated with death in patients with cirrhosis.Conclusion:1.AKI has a high clinical prevalence rate,especially in patients with liver cirrhosis,its prevalence rate is 12.1%;2.ALT and HDL are independent factors of the regression of AKI stage;3.The higher the AKI stage,the worse the prognosis of patients with liver cirrhosis.Preventing the progression of AKI stage may improve the prognosis.