Development of predisposition, injury, response, organ failure model for predicting acute kidney injury in acute on chronic liver failure

作者：Rakhi Maiwall, Shiv Kumar Sarin, Suman Kumar, Priyanka Jain, Guresh Kumar, Ajeet Singh Bhadoria, Richard Moreau, Chandan Kumar Kedarisetty, Zaigham Abbas, Deepak Amarapurkar, Ankit Bhardwaj, Chhagan Bihari, Amna Subhan Butt, Albert Chan, Yogesh Chawla, Ashok Chowdhury, Radhakrishan Dhiman, A. Kadir Dökmeci, Hasmik Ghazinyan, Saeed Hamid, Dong Joon Kim, Piyawat Komolmit, George Lau, Guan Huei Lee, Laurentius A. Lesmana, Kapil Dev Jamwal, Mamun-Al-Mahtab Mamun-Al-Mahtab, Rajendra Prasad Mathur, Suman Lata Nayak, Qin Ning, Viniyendra Pamecha, Diana Alcantara‐Payawal, Archana Rastogi, Salimur Rahman, Mohamed Rela, Vivek A. Saraswat, Samir Shah, Gamal Shiha, Barjesh Chander Sharma, M Sharma, Kapil Sharma, Soek Siam Tan, Shivendra Singh Chandel, Chitranshu Vashishtha, Zeeshan Ahmad Wani, Man‐Fung Yuen, Osamu Yokosuka, Ajay Duseja, Wasim Jafri, Harshad Devarbhavi, CE Eapen, Ashish Goel, Ajit Sood, Jia Ji, Zhongping Duan, Y. Chen · 发表于：Liver International · 年份：2017 · DOI：10.1111/liv.13443 · 被引用次数：34 · 研究领域：Acute Kidney Injury Research、Liver Disease and Transplantation、Drug-Induced Hepatotoxicity and Protection

BACKGROUND AND AIM: There is limited data on predictors of acute kidney injury in acute on chronic liver failure. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting acute kidney injury in a multicentric cohort of acute on chronic liver failure patients. PATIENTS AND METHODS: Data of 2360 patients from APASL-ACLF Research Consortium (AARC) was analysed. Multivariate logistic regression model (PIRO score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of acute on chronic liver failure patients (n=997). RESULTS: Factors significant for P component were serum creatinine[(≥2 mg/dL)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(<12 mg/dL,OR 1) vs (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) vs (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(<3 mmol/LOR-1) vs (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) vs (≥5 mmol/L,OR 4.34, 95% CI 1.67-11.3)] and blood urea (OR 3.73, 95% CI 2.5-5.5); for I component nephrotoxic medications (OR-9.86, 95% CI 3.2-30.8); for R component,Systemic Inflammatory Response Syndrome,(OR-2.14, 95% CI 1.4-3.3); for O component, Circulatory failure (OR-3.5, 95% CI 2.2-5.5). The PIRO score predicted acute kidney injury with C-index of 0.95 and 0.96 in the derivation and validation cohort. The increasing PIRO score was also associated with mortality (P<.001) in both the derivation and validation cohorts. CONCLUSIONS: The PIRO model identifies and stratifies acute on chroni...