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

Maiwall R 1 , Sarin SK 1 , Kumar S 2 , Jain P 3 , Kumar G 3 , Bhadoria AS 3 Show all authors , Moreau R 4 , Kedarisetty CK 1 , Abbas Z 5 , Amarapurkar D 6 , Bhardwaj A 3 , Bihari C 7 , Butt AS 8 , Chan A 9 , Chawla YK 10 , Chowdhury A 1 , Dhiman R 10 , Dokmeci AK 11 , Ghazinyan H 12 , Hamid SS 8 , Kim DJ 13 , Komolmit P 14 , Lau GK 15 , Lee GH 16 , Lesmana LA 17 , Jamwal K 1 , Mamun-Al-Mahtab 18 , Mathur RP 19 , Nayak SL 19 , Ning Q 20 , Pamecha V 21 , Alcantara-Payawal D 22 , Rastogi A 7 , Rahman S 18 , Rela M 23 , Saraswat VA 24 , Shah S 25 , Shiha G 26 , Sharma BC 27 , Sharma MK 1 , Sharma K 1 , Tan SS 28 , Chandel SS 1 , Vashishtha C 1 , Wani ZA 1 , Yuen MF 29 , Yokosuka O 30 , Duseja A 10 , Jafri W 8 , Devarbhavi H 31 , Eapen CE 32 , Goel A 33 , Sood A 34 , Ji J 35 , Duan Z 36 , Chen Y 37 , of the APASL ACLF Research Consortium (AARC) working party

Affiliations 

  • 1 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
  • 2 Department of Clinical Hematology, Command Hospital [Eastern Command], Kolkata, India
  • 3 Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
  • 4 UMR_S1149, Center for Research in Inflammation (CRI), Inserm and Paris Diderot University, Paris, France
  • 5 Department of Gastroenterology, Ziauddin University Hospital, Karachi, Pakistan
  • 6 Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research, Mumbai, India
  • 7 Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
  • 8 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  • 9 Department of Surgery, Division of Hepatobiliary and Pancreatic surgery, and Liver Transplantation, The University of Hong Kong, Hong Kong, China
  • 10 Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 11 Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
  • 12 Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia
  • 13 Center for Liver and Digestive Diseases, Hallym University Chuncheon Sacred Heart Hospital, Gangwon-Do, Korea
  • 14 Department of Medicine, Division of Gastroenterology and Hepatology, Chulalongkorn University, Bangkok, Thailand
  • 15 Department of Hepatology, The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China
  • 16 Department of Medicine, National University Health System, Singapore, Singapore
  • 17 Division of Hepatology, University of Indonesia, Jakarta, Indonesia
  • 18 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 19 Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India
  • 20 Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 21 Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
  • 22 Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines
  • 23 Institute of Liver diseases and Transplantation, Global Health city, Chennai, India
  • 24 Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
  • 25 Department of Hepatology, Global Hospitals, Mumbai, India
  • 26 Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt
  • 27 Department of Gastroenterology, GB Pant Hospital, New Delhi, India
  • 28 Department of Hepatology Selayang Hospital, Selangor, Malaysia
  • 29 Department of Medicine, The University of Hong Kong, Hong Kong, China
  • 30 Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
  • 31 Department of Gastroenterology, St.John's Medical College and Hospital, Bangalore, India
  • 32 Department of Gastroenterology and Hepatology, CMC, Vellore, India
  • 33 Department of Gastroenterology, Rome, NY, USA
  • 34 Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India
  • 35 Department of Gastroenterology, Liver Research Center, Beijing, China
  • 36 Department of Gastroenterology, Nanjing First Hospital, Nanjing, China
  • 37 Department of Gastroenterology, East Brunswick, NJ, USA
Liver Int, 2017 Oct;37(10):1497-1507.
PMID: 28393476 DOI: 10.1111/liv.13443

Abstract

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

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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