Analysis Of Risk Factor Of Decompensated Cirrhotic Patients With Acute Kidney Injury

Objective:To investigate the independent risk factors and the prognosis of acute kidney injury (AKI) in decompensated cirrhotic patients. To evaluate the diagnostic value of serum creatinine, total bilirubin, INR, serum sodium concentration, serum cholinesterase and glomerular filtration rate for acute kidney injury (AKI) in decompensated cirrhotic patients.Methods:126decompensated cirrhotic patients from department of hepatology in Tianjin Third Central Hospital were enrolled in this retrospective analysis. Among these patients,60suffered from AKI,66didn’t suffer from AKI as control group. All patients were followed up0,1,2,3,4years. General condition, laboratory examination, liver and renal functional parameters and prognosis of these patients were recorded. Data was analyzed with SPSS17.0software, t test was used on quantitative data, chi-square was used on qualitative data, then Logistic regression was used to screen independent risk factors affecting prognosis in decompensated cirrhotic patients with AKI. Survival analysis was performed using the Kaplan-Meier method, Log-rank test was used to compare survival rate between two groups. Receiver operating characteristic curve (ROC) and the area under the curve (AUC) was used to compare the diagnostic value of serum creatinine, total bilirubin, INR, serum sodium concentration, serum cholinesterase and glomerular filtration rate for AKI in decompensated cirrhotic patients.Results:In this study, the actual average follow-up time was33.79±18.13months. During the entire follow-up,12patients died in liver cirrhosis group and27patients died in cirrhosis with AKI group. The survival rate decreased in AKI group compared with non-AKI group (55%vs83.33%,x2=13.270, P=0.001). Logistic regression analysis revealed that the increase of serum creatinine, total bilirubin, INR and the decrease of serum sodium concentration, serum cholinesterase and glomerular filtration rate were independent risk factors of decompensated cirrhotic patients with AKI(The OR values were1.034、1.005、2.471、0.910、0.999and0.972, respectively. P<0.05). The AUC of serum sodium concentration was0.828, which was higher than the AUC of INR (0.742), serum cholinesterase (0.714) and total bilirubin (0.725), the difference was statistically significant (The Z values were2.332,3.091and2.911, respectively. P<0.05).Conclusions:Episode of acute kidney injury does not only decrease survival rate but also has adverse effect on prognosis in decompensated cirrhotic patients. Doctors should be alert to deal with the occurrence of AKI. It is benefited to early diagnosis and early treatment for decompensated cirrhotic patients with AKI. The increase of serum creatinine, total bilirubin, INR and the decrease of serum sodium concentration, serum cholinesterase and glomerular filtration rate are independent risk factors in decompensated cirrhotic patients with AKI. All these indicators can predict the occurrence of AKI in decompensated cirrhotic patients. The serum sodium concentration is more effective than other indicators.