Development of predisposition, injury, response, organ failure model for predicting acute kidney injury in acute on chronic liver failure
2017
Background and Aim There is limited data on predictors of
acute kidney injuryin
acuteon
chronic liver failure. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting
acute kidney injuryin a multicentric cohort of
acuteon
chronic liver failurepatients. 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
acuteon
chronic liver failurepatients (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 injurywith 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
acuteon
chronic liver failurepatients at risk of developing
acute kidney injury. It reliably predicts mortality in these patients, underscoring the prognostic significance of
acute kidney injuryin patients with
acuteon
chronic liver failure.
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