Research Of The Prevalence And The Comparison Of RIFLE?AKIN?KDIGO?ICA New Criteria Of The Acute Kidney Injury In Cirrhosis Patients From The First Affiliated Hospital Of Nanchang University

Objective:1?To investigate the incidence of AKI in four diagnostic criteria and to compare the incidence of AKI and mortality in the four diagnostic criteria thus to find out the difference between those four criteria.2?ROC carves and the area under the curve(AUC)were used to compare the predictive ability for long term mortality of four criteria,3 ? Logistic regression was used to screen independent risk factors affecting prognosis in decompensated cirrhotic patients with AKI.Methods:So in this study,We prospectively enrolled 4650 cirrhotic patients from the first affiliated hospital of Nanchang university from 2015-1-1 to 2016-12-30.AKI was defined by the RIFLE,AKIN,and KDIGO and ICA criteria.Demographic parameters and clinical variables on day 1 of admission were prospectively recorded.the baseline serum creatinine is defined as the first serum creatinine obtained on admission.And incidence,stages,and outcomes of AKI were determined according to the RIFLE,AKIN,KDIGO and the ICA new criteria.Model for end-stage liver disease(MELD)?Meld-Na and Child-pugh score were calculated for patients on admission.the two endpoints are set as follow-up 30 days after hospitalization outcome(death or survival),and follow-up 6 months after hospitalization.Results:The overall in-hospital mortality rate was 3.5%.The overall in hospital mortality rate is 1.8% for the non-AKI patients,and 29.6% for the AKI patients,Liver diseases were usually attributed to hepatitis B viral infection(75.6%).The incidence of AKI was highest according to KDIGO criteria(6.1%),followed by ICA(5.16%),AKIN(5%),RIFLE(4.7%)respectively.ICA and KDIGO criteria had a higher sensibility in identification of the presence of AKI;our results show that ICA had better discriminatory power than RIFLE?AKIN?KDIGO criteria in predicting in-hospitalmortality.Especially to early kidney injury,KDIGO criteria plays a better role in identification of the presence of AKI than the other criteria while ICA new criteria was more specificity(92%)for prediction of in-hospital mortality.Cumulative survival rates at the 6-month after hospital discharge differed significantly between patients with and without AKI on admission day.The 6-month mortality was higher for ICA criteria(47.9%)followed by KDIGO criteria(47%),RIFLE criteria(42.9%)and AKIN criteria(46.1%)(P< 0.05)respectively.In-hospital mortality increased in a stepwise manner with severity of AKI..Conclusions:The rate of AKI Patients diagnosed by KDIGO is the highest.Yet there are no significant differences in mortality between those four criteria.ICA new criteria for AKI has a higher specificity than other criteria(RIFLE,AKIN,KDIGO)in predicting short-term prognosis for cirrhosis patients while AKIN and KDIGO criteria have a higher sensibility.6-month mortality increased remarkably with severity of acute kidney injury.In clinical practice,we should take both them into consideration.