Risk Factors And Prognosis Analysis Of Patients With Liver Cirrhosis Complicated With AKI

Objective: The purpose of this study is to analyze the clinical characteristics of patients with liver cirrhosis,explore the potential risk factors of acute kidney injury(AKI)in liver cirrhosis,and further analyze its prognosis,in order to provide a basis for clinical diagnosis and treatment.Methods: From June 2018 to June 2021,738 patients with liver cirrhosis who were hospitalized in the People’s Hospital of Guangxi Zhuang Autonomous Region with complete clinical data were retrospectively analyzed.Compensation period,acute decompensation period)were divided into AKI group and non-AKI group according to the AKI diagnostic criteria recommended by the International Ascites Club.The clinical data of the two groups of patients,including general data,comorbidities,and complications,were analyzed.The K-S method was used to test the normality of the measurement data.The variables that conformed to the normal distribution were analyzed by two independent samples t-test.Variables with normal distribution were analyzed by Mann-Whitney U test;enumeration data were analyzed by chi-square test or Fisher exact probability method.The potential risk factors of AKI in patients with liver cirrhosis were analyzed by logistic regression.Survival analysis was performed using the Kaplan-Meier test.P<0.05 considered the difference to be statistically significant.Results:(1)A total of 738 patients with liver cirrhosis were included in the study,including 196 patients with compensatory phase of liver cirrhosis,542 patients with decompensation phase(73 patients with non-acute decompensation phase and 469 patients with acute decompensation phase).A total of 135 patients with AKI occurred in all patients with liver cirrhosis,including 6 patients with compensatory phase,15 patients with non-acute decompensation phase and 114 patients with acute decompensation phase.The incidence of AKI in liver cirrhosis was 18.29%,of which the proportion of acute decompensation phase was the highest in the stage of liver cirrhosis.(2)According to the Child-pugh grading of cirrhosis,the incidence of acute kidney injury in patients with Child-pugh A,B and C grades of cirrhosis was 5.43%(10/184),16.79%(44/262)and 27.74%(81/292),respectively.Hepatitis B cirrhosis,hepatitis C cirrhosis,alcoholic cirrhosis,primary biliary cirrhosis,cirrhosis of complicated causes(hepatitis B and/or hepatitis C with two or more other causes)The incidence of AKI in patients with cirrhosis of unknown causes(including hepatic veno-occlusive syndrome,Budd-Chiari syndrome,hepatolenticular degeneration,cavernous degeneration of portal vein,cardiogenic or hospitalization meeting the diagnostic criteria for cirrhosis but with unknown etiology)was 18.05%(76/421),15.79%(3/19),21.90%(23/105),17.39%(4/23),20.00%(12/60)and 15.45%(17/110),respectively.(3)Multivariate logistic regression analysis showed that infection(OR=2.400,95%CI 1.436-4.010,P<0.001),acute on chronic liver failure(ACLF)(OR=4.851,95%CI 2.606-9.031,P<0.001),acute decompensation(OR=6.957,95%CI 1.987-24.352,P=0.002),combined diabetes(OR=2.483,95%CI 1.327-4.648,P=0.004)Hyperuricemia(OR=11.211,95%CI 8.285-24.377,P<0.001)is an independent risk factor for AKI in cirrhosis.(4)The average hospitalization days [10(7,15)days] and total hospitalization expenses of 2.64±2.50 ten thousand yuan in the AKI group with cirrhosis were significantly higher than those of the non-AKI group [8(6,12)days] and total hospitalization expenses of 1.68±1.56 ten thousand yuan,P<0.001.The mortality rate of AKI in cirrhosis within 3 months was 28.89%(39/135),of which the mortality rates of AKI stage 1,stage 2 and stage 3 were 18.56%(18/97),40.00%(8/20)and 72.22%(13/18),respectively.Conclusion:(1)In clinical work,attention should be paid to the progressive aggravation of acute gastrointestinal hemorrhage,hepatic encephalopathy,obvious ascites,infection and jaundice in patients with cirrhosis in a short time,and timely intervention should be taken to reduce the incidence of AKI in patients with cirrhosis.(2)Infection,acute on chronic liver failure,acute decompensation,combined diabetes and hyperuricemia are independent risk factors for AKI in patients with cirrhosis.Patients with cirrhosis combined with the above risk factors should be treated as soon as possible to be alert to the occurrence of AKI in cirrhosis.