Title

Development of Predisposition,Injury,Response,Organ failure model for predicting acute kidney injury in acute on chronic liver failure.

Authors

Rakhi Maiwall, Institute of Liver and Biliary Sciences, New Delhi, India.
Shiv Kumar Sarin, Institute of Liver and Biliary Sciences, New Delhi, India.Follow
Suman Kumar, Command Hospital [Eastern Command], Kolkata.
Priyanka Jain, Institute of Liver and Biliary Sciences, New Delhi, India.
Guresh Kumar, Institute of Liver and Biliary Sciences, New Delhi, India.
Ajeet Singh Bhadoria,, Institute of Liver and Biliary Sciences, New Delhi, India.
Richard Moreau, Inserm and Paris Diderot University.
Chandan Kumar Kedarisetty, Institute of Liver and Biliary Sciences, New Delhi, India.
Z Abbas, Agha Khan UniversityFollow
Deepak Amarapurkar, Bombay Hospital and Medical Research, Mumbai, India.
Ankit Bhardwaj, Institute of Liver and Biliary Sciences, New Delhi, India.
Chhagan Bihari, Institute of Liver and Biliary Sciences, New Delhi, India.
Amna Subhan Butt, Agha Khan UniversityFollow
Albert Chan, University of Hong Kong, Hong Kong, China.
Yogesh Kumar Chawla, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Ashok Chowdhury, Institute of Liver and Biliary Sciences, New Delhi, India.
RadhaKrishan Dhiman, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Abdul Kadir Dokmeci, Ankara University School of Medicine, Ankara, Turkey.
Hasmik Ghazinyan H, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia.
Saeed Hamid, Aga Khan UniversityFollow
Dong Joon Kim, Hallym University Chuncheon Sacred Heart Hospital, Gangwon-Do, Republic of Korea.
Piyawat Komolmit, Chulalongkorn University, Bangkok, Thailand.
George K. Lau, The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China.
Guan Huei Lee, National University Health System, Singapore.
Laurentius A. Lesmana, University of Indonesia, Jakarta, Indonesia
Rajendra Prasad Mathur, Institute of Liver and Biliary Sciences, New Delhi.
Suman Lata Nayak,, Institute of Liver and Biliary Sciences, New Delhi.
Qin Ning, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Viniyendra Pamecha,, Institute of Liver and Biliary Sciences, New Delhi, India.
Diana Alcantara- Payawal, Cardinal Santos Medical Center, Manila, Philippines.
Archana Rastogi, Institute of Liver and Biliary Sciences, New Delhi, India.
Salimur Rahman,, Bangabandhu Sheikh Mujib Medical university, Dhaka, Bangladesh.
Mohamed Rela, Global Health city, Chennai, India.
Vivek A , Saraswat, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Samir Shah, Global Hospitals, Mumbai.
Gama Shiha, Egyptian Liver Research Institute and Hospital, Cairo, Egypt.
Barjesh Chander Sharma, GB Pant Hospital, New Delhi, India.
Manoj Kumar Sharma, Institute of Liver and Biliary Sciences, New Delhi, India.
Kapil Sharma, Institute of Liver and Biliary Sciences, New Delhi, India.
Soek Siam Tan, Selayang Hospital, Malaysia.
Shivendra Singh Chandel, Institute of Liver and Biliary Sciences, New Delhi, India.
Chitranshu Vashishtha, Institute of Liver and Biliary Sciences, New Delhi, India.
Zeeshan A. Wani, Institute of Liver and Biliary Sciences, New Delhi, India.
Man- Fung Yuen, The University of Hong Kong, Hong Kong, China.
Osamu Yokosuka, Graduate School of Medicine, Chiba University, Chiba, Japan.

Document Type

Article

Department

Medicine

Abstract

Background and Aim There is limited data on predictors of acute kidney injury(AKI) in ACLF. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting AKI in a multi-centric cohort of ACLF 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 ACLF patients (n=997)

Results Factors significant for P component were serum creatinine[(≥2mg/dl)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(/dL,OR 1) versus (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) versus (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(/LOR-1)versus (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) versus (≥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 AKI 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 < 0.001) in both the derivation and validation cohorts.

Conclusions The PIRO model identifies and stratifies ACLF patients at risk of developing AKI. It reliably predicts mortality in these patients, underscoring the prognostic significance of AKI in patients with ACLF.

Comments

Note: Pages, Vol, Issue No, not mention.

Publication

Liver international : official journal of the International Association for the Study of the Liver.