Risk Factors and Outcomes of Acute Kidney Injury in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

摘要

Abstract Background Acute kidney injury (AKI) is common in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF); however, few studies concerning the risk factors and recovery patterns of renal function have been published. Materials and Methods A retrospective analysis of 150 patients with HBV-ACLF was performed. The occurrence, risk factors and functional recovery of AKI among patients with HBV-ACLF were investigated. Results A total of 90 patients (60%) with HBV-ACLF developed AKI. Patients with AKI had higher creatine kinase ( P = 0.004), total bilirubin ( P = 0.039), HBV viral load ( P = 0.044), serum creatine ( P 0.001) and model for end-stage liver disease (MELD) score ( P 0.001) values and a higher proportion of hepatic encephalopathy ( P = 0.032) and spontaneous bacterial peritonitis (SBP) ( P = 0.042) than patients without AKI. Logistic regression analysis illustrated that SBP (odds ratio = 6.214, P = 0.012) and MELD score (odds ratio = 1.097, P = 0.006) were risk factors for the development of AKI. A subgroup analysis of recovery patterns in renal function showed that patients with a severe AKI stage had worse outcomes ( P = 0.007). The proportion of patients who experienced a complete recovery was higher in survivors than in the overall AKI populations ( P = 0.004). Follow-up studies showed that the no-AKI group had a higher transplant-free survival rate than the AKI group at day 90 (80.0% versus 26.7%, respectively, P 0.001). The survival rate among patients with AKI Stage 1 was higher than that of patients with AKI Stage 2 and patients with AKI Stage 3 ( P 0.001). Conclusions AKI is common in patients with HBV-ACLF. The SBP and MELD score have some prognosis value for patients with AKI. AKI and its stages affect the 90-day transplant-free mortality rate. It is important to focus on exploring the early recognition of AKI and early intervention of those risk factors in individuals with HBV-ACLF.