Research On Hepatitis B Virus Related Acute-on-chronic Liver Failure Complicated With Acute Kidney Injury

Objective: Acute-on-chronic liver failure(ACLF)is a complicated syndrome occurring in patients with underlying chronic liver diseases and carries a high mortality.Hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)has become the most common type of liver failure in China.Acute kidney injury(AKI),which is one of the serious complications of liver failure.AKI not only has a high morbidity,but also greatly increases the mortality of patients with liver failure,increasing the difficulty of treatment for patients with liver failure.The research is aimed at understanding the clinical characteristics of HBV-ACLF with AKI patients,independent factors of AKI progression,and important risk factors for prognosis.Methods: The participants of this study enrolled from The Third Central Hospital of Tianjin,Beijing You An Hospital Affiliated to Capital Medical University,302 Military Hospital of China,The Third Hospital of Hebei Medical University,Shandong Provincial Hospital,First Hospital of Shanxi Medical University,Henan Provincial People's Hospital from January 2013 to June 2019 were screened and analyzed for 921 patients with ACLF retrospectively.Finally,543 patients met the HBV-ACLF diagnostic criteria.There were 120 patients with HBV-ACLF who were diagnosed with AKI.Firstly,the baseline data of HBV-ACLF with AKI and non-AKI group,AKI progression and improvement patients were compared,and then compare the survival rates.Secondly,HBV-ACLF patients with type A,B,and C with and without AKI were also compared for survival rates.Finally,through univariate and multivariate COX analysis,we found the independent factors of prognosis of HBV-ACLF patients,as well as HBV-ACLF with AKI.Furthermore,we performed multivariate logistic analysis of independent risk factors for HBV-ACLF with AKI;independent risk factors for the progression of HBV-ACLF with AKI.Results: 1.A total of 120 patients was HBV-ACLF(22.1%)with AKI.Comparison with baseline data of non-AKI,the age,men,total bilirubin(TBil),blood urea nitrogen(BUN)and serum creatinine(s Cr)of the AKI group were higher.The causes were compared between the two groups,and infection was the most common cause in the AKI group,especially SBP.In terms of criticality score for failure,the CTP score,MELD score,CLIF-OFs,CLIF-C ACLFs,HBV-SOFA score,and COSSH-ACLFs scores were significantly increased in patients with AKI;the majority of patients in the AKI group are in grade 2 and 3.2.The patients in the AKI improvement group and progression group were 67 and 53 respectively.Among them,the age,BUN,s Cr,and WBC in the AKI progression group were significantly higher,but serum sodium and chlorine were lower.And the MELD score,CLIF-C ACLFs,HBV-SOFA score and COSSH-ACLFs of the AKI progression group patients were higher than the improvement group patients.3.The 90-day and total survival rate of HBV-ACLF patients with AKI were significantly lower,regardless of the type of liver failure.The 90-day and total mortality of patients with AKI progression was higher than improvement group.4.Baseline age,sex,TBil,BUN,infection,liver failure grade 2,3 were independent risk factors for AKI by multivariate logistic regression.Moreover,baseline CLIF-C ACLFs,HBV SOFA score and BUN were risk factors for the progression of AKI.5.Besides CTP,CLIF-C ACLFs,TBil,and liver failure grade 2 and 3 of HBV-ACLF patients were independent risk factors for short and long-term prognosis.AKI was also an important independent risk factor.Further analysis on the short-term prognosis of HBV-ACLF with AKI were the progression of AKI,CLIF-C ACLFs and WBC,while the independent risks of long-term prognosis were the progression of AKI and CLIF-C ACLFs.Conclusion: HBV-ACLF patients were prone to complicating AKI.Once AKI appeared on the basis of liver failure,regardless of the type of liver failure,the mortality of patients increased significantly,and the mortality of patients with AKI progression increased drmatically.AKI was an independent risk factor for the prognosis of HBV-ACLF patients,and the progression of AKI was an important risk factor for the prognosis of HBV-ACLF patients with AKI.Therefore,early recognition and active treatment of AKI played a vital role in improving prognosis of HBV-ACLF patients.