Comparison Of Different Criteria And Causes For AKI Evaluating Short-term Prognosis Of Patients With ACLF

Objective: 1.This study is aim to compare the different criteria(RIFLE, AKIN, KDIGO and conventional criteria) for acute kidney injury in evaluating the incidence and mortality of acute kidney injury in patients with acute-on-chronic liver failure(ACLF). 2. To evaluate the association of the causes of acute kidney injury with mortality in patients with ACLF.Methods: 1.We evaluated 358 patients with ACLF admitted to the Tianjin Third Center Hospital between July 2008 and March 2014. Serum creatinine obtained on admission used as baseline creatinine value and the incidence, stages, and outcomes of AKI were determined according to the RIFLE, AKIN, KDIGO and conventional criteria. Glomerular filtration rate was measured by the MDRD equation. Model for end-stage liver disease(MELD) and Child-pugh score were calculated for each patient on admission. The predictive ability for 30 days mortality of the four criteria was compared by ROC curves. 2. We recruited 385 patients with ACLF and identificated the causes of acute kidney injury in patients with ACLF. The outcomes of patients were predicted according to different causes of AKI. The 90-day survival probability curves were calculated with the Kaplan-Meier method and compared with log-rank test. Multivariate logistic regression analyses were used to select main factors associated with the endpoint.Results:1. The incidence of AKI was highest according to KDIGO criteria(45.0%), followed by AKIN(38.8%), RIFLE(35.5%) and conventional criterion(20.4%), respectively. AKIN and KDIGO criteria had a higher sensibility(72%), especially to early kidney injury, in identification of the presence of AKI than the other criteria while conventional criterion was more specificity(92%) for prediction of in-hospital mortality. The AUC for 30 days mortality was higher for conventional criteria(0.75) followed by AKIN criteria(0.72), RIFLE criteria(0.70) and KDIGO criteria(0.69)(P < 0.05), respectively. In-hospital mortality increased in a stepwise manner with severity of AKI. 2. In patients with ACLF, the three most frequent causes of AKI were bacteria infection(55.6%), followed by hypovelemia(22.2%) and HRS(14.4%), account for 92.2% of all cases. The 90-day’ mortality is closely associated with thecauses of AKI, which highest in HRS, followed by infection, hypovelemia, nephrotoxicity and miscellaneous. In addition, mortality of patients with a shock or those without renal recovery was 86.2%.Conclusion: 1. Conventional criterion for AKI has a higher specificity than other criteria(ie, RIFLE, AKIN, KDIGO) in predicting short-term prognosis for patients with acute-on-chronic liver failure while AKIN and KDIGO criteria have a higher sensibility. In-hospital mortality increased in a stepwise manner with servity of acute kidney injury. In clinical practice, we should take both them into consideration. 2. In patients with ACLF, the three most frequent causes of AKI were bacteria infection(55.6%), followed by hypovelemia(22.2%) and HRS(14.4%), account for about 90.0% of all cases. In addition, the 90-day’ mortality is closely associated with the causes of AKI. Patients with HRS, a shock or those with no renal recovery had the worst prognosis.