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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 7
Jul.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(7): 1561-1565

Risk factors for the 90-day prognosis of patients with type I hepatorenal syndrome and establishment of a predictive model

DOI: 10.3969/j.issn.1001-5256.2022.07.019
  • 1.

    Department of Spleen and Stomach, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China

  • 2.

    Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

Research funding:

Approved projects for the Capital Health Development Research Project (2018-1-2172)

More Information
  • Corresponding author: WANG Xianbo, wangxianbo638@163.com(ORCID: 0000-0002-3593-5741)
  • Received Date: 2021-11-24
  • Accepted Date: 2021-12-26
  • Published Date: 2022-07-20
    Abstract
  •   Objective  To investigate the risk factors for the 90-day prognosis of patients with decompensated liver cirrhosis and type I hepatorenal syndrome (HRS).  Methods  A retrospective analysis was performed for the clinical data of 299 patients with decompensated liver cirrhosis and type I HRS who were hospitalized in Beijing Ditan Hospital from October 2008 to October 2018, and according to the 90-day prognosis, they were divided into survival group with 135 patients and death group with 164 patients. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate binary logistic regression analysis was used to investigate the influencing factors for 90-day prognosis, and the receiver operating characteristic (ROC) curve was plotted for each factor.  Results  The univariate analysis showed that there were significant differences between the two groups in Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, hepatic encephalopathy, serum Na, serum creatinine (Cr), blood urea nitrogen (BUN), uric acid (UA), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), albumin (Alb), cholinesterase (CHE), white blood cell count (WBC), neutrophil (NE), neutrophil-to-lymphocyte ratio (NLR), red blood cell count (RBC), red blood cell distribution width (RDW), platelet count (PLT), and international normalized ratio (INR) (P < 0.05). The multivariate logistic regression analysis showed that Na (odds ratio [OR]=0.918, 95% confidence interval [CI]: 0.880-0.957, P < 0.05), BUN (OR=1.077, 95% CI: 1.029-1.127, P < 0.05), RDW (OR=1.019, 95% CI: 1.005-1.032, P < 0.05), and INR (OR=3.478, 95% CI: 2.096-5.771, P < 0.05) were independent influencing factors for poor 90-day prognosis in patients with decompensated liver cirrhosis and type I HRS. A predictive model, HRS-D, was established using the four factors above, and the ROC curves were plotted for each factor to calculate the area under the ROC curve (AUC), which showed that HRS-D had an AUC of 0.813 (95% CI: 0.762-0.864), with a sensitivity of 76.50% and a specificity of 72.50% at the diagnostic cut-off value of -1.264. There was a significant difference between HRS-D score and MELD score (Z=3.804, P < 0.001), while there was no significant difference between HRS-D score and CTP score and between CTP score and MELD score (both P > 0.05).  Conclusion  Na, BUN, RDW, and INR are independent influencing factors for poor 90-day prognosis in patients with decompensated liver cirrhosis and type I HRS, and the predictive model based on these indices can better predict the 90-day prognosis of HRS patients.

     

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    • References(14)
  • [1]
    WONG LP, BLACKLEY MP, ANDREONI KA, et al. Survival of liver transplant candidates with acute renal failure receiving renal replacement therapy[J]. Kidney Int, 2005, 68(1): 362-370. DOI: 10.1111/j.1523-1755.2005.00408.x.
    [2]
    ALLEGRETTI AS, ORTIZ G, WENGER J, et al. Prognosis of acute kidney injury and hepatorenal syndrome in patients with cirrhosis: A prospective cohort study[J]. Int J Nephrol, 2015, 2015: 108139. DOI: 10.1155/2015/108139.
    [3]
    Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B: A 2015 update[J]. J Clin Hepatol, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.
    [4]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the management of ascites and complications in cirrhosis Chinese Society of Hepatology[J]. J Clin Hepatol, 2017, 33(10): 1847-1863. DIO: 10.3969/j.issn.1001-5256.2017.10.003. DOI: 10.3969/j.issn.1001-5256.2017.10.003

    中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863. DOI: 10.3969/j.issn.1001-5256.2017.10.003.
    [5]
    YE YN, ZHANG ZQ, HE G, et al. Analysis of high-risk factors for hepatorenal syndrome in patients with hepatitis B-related acute-on-chronic liver failure[J]. Hainan Med J, 2019, 30(24): 3145-3149. DOI: 10.3969/j.issn.1003-6350.2019.24.004.

    叶一农, 张志侨, 何纲, 等. 乙型肝炎相关慢加急性肝衰竭患者发生肝肾综合征的高危因素分析[J]. 海南医学, 2019, 30(24): 3145-3149. DOI: 10.3969/j.issn.1003-6350.2019.24.004.
    [6]
    LIU PP, LIU J, YE WF. Relationship between Cys-C, hyponatremia, blood ammonia and hepatorenal syndrome[J]. Contemp Med, 2019, 25(19): 82-84. DOI: 10.3969/j.issn.1009-4393.2019.19.033.

    刘萍萍, 刘娟, 叶文峰. Cys-C、低钠血症、血氨与肝肾综合征的关系[J]. 当代医学, 2019, 25(19): 82-84. DOI: 10.3969/j.issn.1009-4393.2019.19.033.
    [7]
    MA Y, WANG XZ, YAN GW, et al. Effect of hyponatremia on prognosis of patients with decompensated hepatitis B cirrhosis[J]. Med Recapitulate, 2021, 27(4): 796-803, 808. DOI: 10.3969/j.issn.1006-2084.2021.04.032.

    马燕, 王晓忠, 延国威, 等. 低钠血症对乙肝肝硬化失代偿期患者预后的影响[J]. 医学综述, 2021, 27(4): 796-803, 808. DOI: 10.3969/j.issn.1006-2084.2021.04.032.
    [8]
    MA Y, WANG XZ, YAN GW, et al. The relationship between serum sodium, creatinine, cystatin C and the degree of renal damage in patients with hepatitis B liver cirrhosis and hyponatremia[J]. Med Inf, 2020, 33(19): 55-58. DOI: 10.3969/j.issn.1006-1959.2020.19.017.

    马燕, 王晓忠, 延国威, 等. 乙肝肝硬化低血钠症患者血清钠、肌酐以及胱抑素C与肾功能损害程度的关系[J]. 医学信息, 2020, 33(19): 55-58. DOI: 10.3969/j.issn.1006-1959.2020.19.017.
    [9]
    XU XY, DIAO ZL, SU JR. Reduction in estimated glomerular filtration rate in patients with elevated blood urea nitrogen but normal for any other markers of kid- ney damage[J]. J Clin Exp Med, 2017, 16(22): 2262-2264. DOI: 10.3969/j.issn.1671-4695.2017.22.025.

    徐小用, 刁宗礼, 苏建荣. 单纯血尿素氮升高患者肾小球滤过率下降趋势分析[J]. 临床和实验医学杂志, 2017, 16(22): 2262-2264. DOI: 10.3969/j.issn.1671-4695.2017.22.025.
    [10]
    BHUTTO AR, ABBASI A, ABRO AH. Correlation of hemoglobin A1c with red cell width distribution and other parameters of red blood cells in type Ⅱ diabetes mellitus[J]. Cureus, 2019, 11(8): e5533. DOI: 10.7759/cureus.5533.
    [11]
    BLASLOV K, KRULJAC I, MIROŠEVIĆ G, et al. The prognostic value of red blood cell characteristics on diabetic retinopathy development and progression in type 2 diabetes mellitus[J]. Clin Hemorheol Microcirc, 2019, 71(4): 475-481. DOI: 10.3233/CH-180422.
    [12]
    FAN JQ, FAN YQ, LI ZJ. Value of red blood cell distribution width in prognosis of acute kidney injury associated with sepsis[J]. Hainan Med J, 2014, 25(20): 3012-3014. DOI: 10.3969/j.issn.1003-6350.2014.20.1184.

    范金强, 范银强, 李振军. 红细胞体积分布宽度对脓毒症急性肾损伤患者预后的评估价值[J]. 海南医学, 2014, 25(20): 3012-3014. DOI: 10.3969/j.issn.1003-6350.2014.20.1184.
    [13]
    HSIEH YP, CHANG CC, KOR CT, et al. The predictive role of red cell distribution width in mortality among chronic kidney disease patients[J]. PLoS One, 2016, 11(12): e0162025. DOI: 10.1371/journal.pone.0162025.
    [14]
    WANG Z, HOU W, WANG KF, et al. Risk factors of 30 days readmission and 3 years mortality of patients with liver cirrhosis and ascites[J/CD]. Chin J Liver Dis (Electronic Version), 2021, 13(3): 16-24. DOI: 10.3969/j.issn.1674-7380.2021.03.003.

    王征, 侯维, 王克菲, 等. 肝硬化腹水患者30 d再住院和3年病死的危险因素分析[J/CD]. 中国肝脏病杂志(电子版), 2021, 13(3): 16-24. DOI: 10.3969/j.issn.1674-7380.2021.03.003.
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