Risk Factors And Short-term Prognosis Analysis Of Patients With HBV-related Decompensated Cirrhosis/HBV-ACLF Complicated With Acute Kidney Disease

Background and objective:Hepatitis B virus(HBV)infection is one of the leading causes of cirrhosis.As the disease progresses,it can enter a more serious stage of HBV-related decompensated cirrhosis.At this time,various serious complications often occur and the prognosis is inferior.At the same time,HBV infection is also the leading cause of acute-on-chronic liver failure(ACLF)in the Asia-Pacific region.Patients diagnosed with ACLF usually have a higher incidence of extrahepatic organ failure.Hepatorenal syndrome(HRS)is one of the most common serious complications affecting the prognosis of HBV-related decompensated cirrhosis and ACLF and is a typical representative of multiple organ failure.Acute kidney disease(AKD)represents a continuum of renal injury after initial renal injury/stress or renal function that cannot be restored.It can describe the continuous impairment of renal function that cannot be diagnosed as chronic kidney disease(CKD)in hepatorenal syndrome-non-acute kidney injury(HRS-NAKI).There are relatively few studies on the occurrence and short-term prognosis of AKD in patients with HBV-related decompensated cirrhosis and HBV-ACLF.The aim of this study was to analyze the risk factors for AKD in patients with HBV-related decompensated cirrhosis and HBV-ACLF,and to assess the impact of AKD on the short-term prognosis of patients with HBV-related decompensated cirrhosis,with the aim of early identification and timely intervention of patients at high risk of AKD in HBV-related decompensated cirrhosis and HBV-ACLF in the clinic,and in order to prevent disease progression and improve prognosis to the greatest extent.Methods:The inpatients with HBV-related decompensated cirrhosis who were firstly treated in the First Hospital of Lanzhou University from January 2020 to December 2021 were screened.The patients were strictly excluded and followed up90 days after discharge.Finally,133 subjects were included,including 116 patients with HBV-ACLF.The patients with HBV-related decompensated cirrhosis and HBV-ACLF were divided into the AKD group and the non-AKD group.The general clinical characteristics,complications,and laboratory examination indexes of each group were analyzed and compared.At the same time,according to the follow-up results of 133 patients with HBV-related decompensated cirrhosis 90 days after discharge,they were divided into a death group and a survival group.The basic clinical data and laboratory examination indexes of the two groups were analyzed and compared.In statistical analysis,independent sample T-test,univariate and multivariate logistic regression analysis were used to screen out the risk factors of AKD in patients with HBV-related decompensated cirrhosis and HBV-ACLF,and then chi-square test and multivariate logistic regression analysis were used to evaluate the effect of AKD on the short-term prognosis of patients with HBV-related decompensated cirrhosis.Results:1.In patients with HBV-related decompensated cirrhosis,the incidence of AKD was 38.3%(51/133).Compared with the non-AKD group,the AKD group had a smaller proportion of males,older age,and a higher probability of diabetes,spontaneous bacterial peritonitis(SBP),and refractory ascites(all P<0.05).Albumin(ALB)and estimated glomerular filtration rate(e-GFR)in the AKD group were lower than those in the non-AKD group,while serum creatinine(SCr)level,urea nitrogen(BUN)level,infection index,and model for end-stage liver disease(MELD)score were higher than those in the non-AKD group(all P<0.05).Multivariate analysis showed that SBP(OR=12.251,95%CI 1.049～143.052)and low e-GFR(OR=0.872,95%CI 0.824～0.922)were independent influencing factors of AKD in patients with HBV-related decompensated cirrhosis.2.The incidence of AKD was 30.2%(35/116)in HBV-ACLF patients.Compared with patients in the non-AKD group,patients in the AKD group were older and had lower body mass index(BMI).Moreover,ALB and Na~+in the AKD group were significantly lower than those in the non-AKD group,while TBIL,infection index,MELD score,BUN,and SCr levels were significantly higher than those in the non-AKD group,and the incidence of SBP complications was higher in AKD group(all P<0.05).Multivariate analysis showed that Na~+(OR=0.886,95%CI 0.791～0.993)and CRP(OR=1.037,95%CI 1.016～1.157)were independent influencing factors of AKD in HBV-ACLF patients,and MELD score(OR=1.076,95%CI 1.001～1.157)was one of the important indicators to judge the poor prognosis(all P<0.05).3.During the follow-up period of 90 days after discharge,45 patients with HBV-related decompensated cirrhosis died,including 29 patients with AKD.88 cases survived,including 22 cases with AKD.The incidence of AKD in dead patients was64.4%.Multivariate analysis showed that AKD(OR=4.385,95%CI 1.739～11.060)was an independent risk factor for 90-day death in patients with HBV-related decompensated cirrhosis,and MELD score(OR=1.229,95%CI 1.120～1.348)was one of the important indicators to judge the 90-day death outcome(all P<0.05).Conclusions:1.SBP and e-GFR may be the key influencing factors of AKD in patients with HBV-related decompensated cirrhosis.2.Na~+and CRP may be the key influencing factors of AKD in patients with HBV-ACLF,and the MELD score is one of the important indicators to judge its poor prognosis.3.The occurrence of AKD has an important impact on the short-term adverse outcomes of patients with HBV-related decompensated cirrhosis.