AKI persistence at 48 h predicts mortality in patients with acute on chronic liver failure

Maiwall, Rakhi; Kumar, Guresh; Bharadwaj, Ankit; Jamwal, Kapil Dev; Bhadoria, Ajeet Singh; Jain, Priyanka; Sarin, Shiv Kumar

doi:10.1007/s12072-017-9822-1

Cited by 16 publications

(15 citation statements)

References 22 publications

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“…Besides, AKI was also very common in these subjects with ACLF; over two-thirds (69%) of ACLF patients had AKI. This figure was much higher than the prevalence of 47% reported by the AARC group 16…”

Section: Discussioncontrasting

confidence: 59%

“…So, waiting for 48 h to see if there is reversal of AKI in these patients is not a worthwhile proposition, as it could delay intervention and prognostication of these patients. The published paper from the AARC study16 states, “AKI persistence at 48 h predicts mortality in patients with [ACLF]”. The authors looked at the status of AKI at different time points with respect to day 1 and prediction of 1-month mortality, and they found increased odds ratio (OR) at day 6 (OR: 4.4) versus day 2 (OR: 3.7).…”

Section: Discussionmentioning

confidence: 99%

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Acute Kidney Injury at Admission Is a Better Predictor of Mortality than Its Persistence at 48 h in Patients with Acute-on-chronic Liver Failure

Khatua

Panigrahi

Mishra

et al. 2018

Journal of Clinical and Translational Hepatology

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Background and Aims: Acute kidney injury (AKI) occurs commonly in patients with acute-on-chronic liver failure (ACLF). However, there are scant data regarding the impact of AKI on survival in ACLF. We performed a prospective study to evaluate the impact of AKI on survival in ACLF.Methods: This study was conducted in ACLF patients hospitalized in the Gastroenterology Department of Sriram Chandra Bhanja Medical College (India) between October 2016 and February 2018. Demographic, clinical and laboratory parameters were recorded, and outcomes were compared between patients with and without AKI and between patients with persistent AKI and AKI reversal at 48 h.Results: We screened 439 chronic liver disease patients as per the Asian Pacific Association for the Study of the Liver criteria and found that 113 (25.7%) of them had ACLF and 78 (69%) of them had AKI as per the Acute Kidney Injury Network criteria. ACLF patients with AKI had reduced 28-day survival (44.9% vs. 74.3%; p = 0.004) and 90-day survival (25.6% vs. 51.4%; p = 0.007), in comparison to ACLF patients without AKI. However, when comparison was made between AKI reverters and AKI persisters at 48 h, survival was comparable for both at 28 days and 90 days. Further, about one-tenth of ACLF patients with AKI died within 48 h of hospitalization.Conclusions: Over two-thirds of ACLF patients had AKI. Although ACLF itself is a predictor of reduced survival, a very small increase in serum creatinine further worsens survival. Importantly, AKI at admission is a better predictor of early mortality in ACLF patients since recovery from AKI at 48 h does not improve survival.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury at Admission Is a Better Predictor of Mortality than Its Persistence at 48 h in Patients with Acute-on-chronic Liver Failure

Khatua

Panigrahi

Mishra

et al. 2018

Journal of Clinical and Translational Hepatology

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“…Maiwall et al . [ 25 ] suggested that patients with acute or chronic liver failure with AKI had greater potential for prevention and early detection (48 h) and that Cr as low as 100.80 μmol/L (11.4 mg/L) should be considered of clinical intervention. In this study, the baseline level of Cr was 76.92 ± 67.20 μmol/L, which was lower than the value stated above.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Serum Creatinine, Blood Urea Nitrogen, Uric Acid, and β 2-Microglobulin in the Evaluation of Acute Kidney Injury after Orthotopic Liver Transplantation

Huang

Ning

Chen

et al. 2018

Chinese Medical Journal

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Background:As a major complication after orthotopic liver transplantation (OLT), the occurrence of acute kidney injury (AKI) is frequently defined by serum creatinine (Cr); however, the accuracy of commonly used blood urea nitrogen (BUN), uric acid (UA), and β2-microglobulin (β2-MG) remains to be explored. This retrospective study compared the accuracy of these parameters for post-OLT AKI evaluation.Methods:Patients who underwent OLT in three centers between July 2003 and December 2013 were enrolled. The postoperative AKI group was diagnosed by the Kidney Disease Improving Global Outcomes (KDIGO) criteria and classified by stage. Measurement data were analyzed using the t-test or Wilcoxon rank-sum test; enumerated data were analyzed using the Chi-square test or Fisher's exact test. Diagnostic reliability and predictive accuracy were evaluated using receiver operating characteristic (ROC) curve analysis.Results:This study excluded 976 cases and analyzed 697 patients (578 men and 119 women); the post-OLT AKI incidence was 0.409. Compared with the no-AKI group, the AKI group showed very significant differences in Model for End-stage Liver Disease score (14.74 ± 9.91 vs. 11.07 ± 9.54, Z = 5.404; P < 0.001), hepatic encephalopathy (45 [15.8%] vs. 30 [7.3%], χ2 = 12.699; P < 0.001), hemofiltration (28 [9.8%] vs. 0 [0.0%], χ2 = 42.171; P < 0.001), and 28-day mortality (23 [8.1%] vs. 9 [2.2%], χ2 = 13.323; P <0.001). Moreover, mean values of Cr, BUN, UA, and β2-MG in the AKI group differed significantly at postoperative days 1, 3, and 7 (all P < 0.001). ROC curve area was 0.847 of Cr for the detection of AKI Stage 1 (sensitivity 80.1%, specificity 75.7%, cutoff value 88.23 μmol/L), 0.916 for Stage 2 (sensitivity 87.6%, specificity 82.6%, cutoff value 99.9 μmol/L), and 0.972 for Stage 3 (sensitivity 94.1%, specificity 88.2%, cutoff value 122.90 μmol/L).Conclusion:The sensitivity and specificity of serum Cr might be a high-value indicator for the diagnosis and grading of post-OLT AKI.

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“…Our study showed that the sensitivity and speficity of NGAL protein are 100% and 90% after test with 73 urine samples using ELAA method and aptamer NA53, respectively. However, the sensitivity and speficity of other traditional markers are inferior to NGAL protein in our study, such as 61% and 61% with serum creatinine [33], 82.2% and 76.4% with serum cystatin C [34], 70.8% and 90.9% with pNGAL [35], and 77.1% and 73.3% with urinary NGAL protein [36], respectively. Our results revealed that the NGAL protein in urine has higher sensitivity and specificity as AKI diagnosis with ELAA method, which was established with aptamer NA53.…”

Section: Discussionmentioning

confidence: 64%

Development of a novel ssDNA aptamer targeting neutrophil gelatinase-associated lipocalin and its application in clinical trials

et al. 2019

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Background Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker of early diagnosis and prediction for acute kidney injury (AKI). However, the current program for NGAL detection is not extensively applied in clinics due to the high expense of antibodies. Nucleic acid aptamers are single-strand DNAs or RNAs which could bind to targets with high specificity and affinity, and they have been widely used in the diagnosis and therapy for multiple diseases. It is valuable for us to develop a new method for NGAL detection using aptamers instead of antibodies to achieve increased efficiency and decreased cost. Methods Nucleic acid aptamers against NGAL were obtained after SELEX process using magnetic beads, and an enzyme-linked aptamer analysis (ELAA), which can be widely used in clinical diagnosis at low cost, were successfully established. The feasibility of ELAA was further validated with urine samples harvested from 43 AKI patients and 30 healthy people. Results Three candidate aptamers, including NA36, NA42 and NA53, were obtained after 8 rounds of SELEX process with magnetic beads and verified by quantitative polymerase chain reaction (qPCR), and the Kd value of each aptamer was 43.59, 66.55 and 32.52 nM, respectively. Moreover, the linear relationship was consistent at the range of 125–4000 ng/mL, and the detection limit of ELAA assay was 30.45 ng/mL. We also found that NGAL could be exclusively detected with NA53, and no cross-reaction between NA53 and human albumin or globulin occurred, the coefficient of variation (CV) between inner-plate and inter-plate was less than 15%, and the recovery rate was between 80 and 110%. Moreover, the sensitivity and specificity of ELAA assay in this study are 100% and 90%, respectively. Consistently, these results could also diagnose whether the occurrence of AKI in lots of patients, which has been demonstrated with the ELAA method we established after using NA53. Conclusions Taken together, NA53, the best candidate aptamer targeting NGAL protein, can be applied in clinical testing. Electronic supplementary material The online version of this article (10.1186/s12967-019-1955-7) contains supplementary material, which is available to authorized users.

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AKI persistence at 48 h predicts mortality in patients with acute on chronic liver failure

Abstract: AKI persistence at 48 h predicts mortality better than serum creatinine of 1.5 mg/dl in patients with ACLF. Serum creatinine value of 1.14 mg/dl and smaller increases in its value should be considered for risk stratification of patients with ACLF for interventional strategies.

Cited by 16 publications

References 22 publications

Acute Kidney Injury at Admission Is a Better Predictor of Mortality than Its Persistence at 48 h in Patients with Acute-on-chronic Liver Failure

Acute Kidney Injury at Admission Is a Better Predictor of Mortality than Its Persistence at 48 h in Patients with Acute-on-chronic Liver Failure

Predictive Value of Serum Creatinine, Blood Urea Nitrogen, Uric Acid, and β 2-Microglobulin in the Evaluation of Acute Kidney Injury after Orthotopic Liver Transplantation

Development of a novel ssDNA aptamer targeting neutrophil gelatinase-associated lipocalin and its application in clinical trials

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