Zeeshan A. Wani, Guresh Kumar, Soek Siam Tan, Ashish Goel, Barjesh Chander Sharma, Mamun-Al-Mahtab, Amna Subhan Butt, Guan Huei LEE, Harshad Devarbhavi, Albert Chan, Chandan Kumar Kedarisetty, Richard Moreau, Ajay Duseja, RadhaKrishan Dhiman, Saeed Sadiq Hamid, Mohamed Rela, Kapil Sharma, Vivek A. Saraswat, Z. Duan, Viniyendra Pamecha, Rajendra Prasad Mathur, Osamu Yokosuka, Suman Lata Nayak, Laurentius A. Lesmana, Abdul Kadir Dokmeci, Priyanka Jain, Gamal Shiha, Ajeet Singh Bhadoria, Manoj Kumar Sharma, Archana Rastogi, Dong Joon Kim, Yogesh Kumar Chawla, Shiv Kumar Sarin, Rakhi Maiwall, , Suman Kumar, Jia Ji, Wasim Jafri, Chitranshu Vashishtha, Diana Alcantara-Payawal, Qin Ning, Hasmik Ghazinyan, Chhagan Bihari, George K. Lau, Kapil Jamwal, Y. Chen, C. E. Eapen, Man-Fung Yuen, Shivendra Singh Chandel, Ashok Chowdhury, Salimur Rahman, Ankit Bhardwaj, Ajit Sood, Piyawat Komolmit, Samir Shah, Deepak Amarapurkar, Zaigham Abbas
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 chronic liver failure patients at risk of developing acute kidney injury. It reliably predicts mortality in these patients, underscoring the prognostic significance of acute kidney injury in patients with acute on chronic liver failure.
