| Objective:1.Investigate the incidence of acute kidney injury(AKI)in patients with decompensated cirrhosis in our hospital;2.Analyze the predictors of outcome during hospitalization in patients with AKIstage 1 decompensated cirrhosis3.Analyze the predictors of death within 30 days after admission in patients with decompensated cirrhosis and AKI;4.Establish and verify the prediction model of death in patients with decompensated cirrhosis and AKI within 30 days after admission;Methods:Through the joint Medical record management system of the First Affiliated Hospital of Nanchang University,decompensated cirrhosis patients hospitalized in the Department of Gastroenterology and the Department of Infectious Diseases from January 1,2015 to December 31,2020 were screened,and the clinical data of AKI patients meeting the 2015(the International Club of Ascites)ICA-AKI diagnostic criteria were included and analyzed.To investigate the incidence of AKI in patients with decompensated cirrhosis,compare the differences among patients with different stages of AKI.analyze the factors influencing the outcome of AKI stage1 patients,and to explore the relationship between the progression of AKI and the prognosis of patients with cirrhosis.The survival situation of patients within 30 days after admission was analyzed,and the predictive factors of death were analyzed by COX regression,and the nomogram prediction model was established to predict the risk of death within 30 days after admission and verified.Results:(1)The incidence of AKI in patients with decompensated cirrhosis was 16.5%。Among the 330 patients included in the study,male accounted for 79.1%,aged53.6±12.4 years)and AKI stage 1 was 53.7%,AKI stage 2 was17.3%,AKI stage 3was18.4%;79.4% of patients had hepatitis B related cirrhosis.(2)19.2%(38/198)of AKI stage 1 patients progressed to stage AKI stage2 / AKI stage 3,and the independent predictor of AKI stage 1 progression was the presence of chronic acute liver failure(ACLF)at admission(HR: 2.571,95%CI: 1.143-5.780,P=0.022).(3)The mortality rate was 50% in 30 days of follow-up after AKI diagnosis,and the mortality rates of AKI stage 1,2 and 3 were 43.4%(86/198),59.4%(38/64)and60.3%(41/68),respectively.There was no statistical difference in the mortality rates of AKI stage 2 and 3.They were significantly higher than those in AKI stage 1(P=0.026,P=0.016).CTP-C grade at admission(HR: 1.729,95%CI:1.017-2.937,P=0.043),End-stage liver disease score(MELD)(HR: 1.030,95%CI:1.010-1.051,P=0.004),spontaneous peritonitis(SBP)(HR :1.707,95%CI:1.251-2.329,P=0.001)and overt hepatic encephalopathy(HE)(HR: 1.404,95%CI:1.010-1.951,P=0.043)was an independent risk factor for death within 30 days after admission;(4)The mortality rate of the training group was 46.6%(90/193),and that of the verification group was 54.7%(75/137),White blood cell count(95%CI: 1.011-1.085,P=0.010),international standardized ratio(INR)(95%CI: 1.334-2.257,P<0.001),overt hepatic encephalopathy on admission(95%CI: 1.022-2.413,P=0.039)and AKI stage 3(95%CI: 1.220-3.146,P=0.005)were independent risk factors for death within 30 days after admission in patients with cirrhosis and AKI in the training group.(5)The nomogram based on baseline white blood cell count,INR,presence of hepatic encephalopathy,and AKI stage were better predictors of the risk of death within 30 days after admission(C index 0.680 in the training group and 0.683)in the validation group,both not worse than CTP score and MELD score for predicting death).Conclusion:AKI is more common in patients with decompensated cirrhosis,and its occurrence and development are related to the poor outcomes of patients with cirrhosis.The nomogram prediction model was used to predict the risk of death within 30 days after admission and was not worse to CTP and MELD.Early identification and management of risk factors associated with AKI progression and death in patients with decompensated cirrhosis is essential。... |
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