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

Maiwall, Rakhi; Sarin, Shiv Kumar; Kumar, Suman; Jain, Priyanka; Kumar, Guresh; Bhadoria, Ajeet Singh; Moreau, Richard; Kedarisetty, Chandan Kumar; Abbas, Zaigham; Amarapurkar, Deepak; Bhardwaj, Ankit; Bihari, Chhagan; Butt, Amna Subhan; Chan, Albert Chi‐Yan; Chawla, Yogesh; Chowdhury, Ashok; Rk, Dhiman; Dokmeci, A. Kadir; Ghazinyan, Hasmik; Salehiniya, Hamid; Kim, Dong Joon; Komolmit, Piyawat; Lau, George; LEE, Guan Huei; Lesmana, Laurentius A.; Jamwal, Kapil Dev; Mamun-Al-Mahtab, .; Mathur, Rajendra Prasad; Nayak, Subhashree; Ning, Qin; Pamecha, Viniyendra; Alcantara-Payawal, Diana; Rastogi, Archana; Rahman, Salimur; Rela, Mohamed; Saraswat, Vivek A.; Shah, Samir; Shiha, Gamal; Sharma, Barjesh Chander; Sharma, Manoj Kumar; Sharma, Kapil; Tan, Soek Siam; Chandel, Shivendra Singh; Vashishtha, Chitranshu; Wani, Zaid Ahmad; Yuen, Man‐Fung; Yokosuka, Osamu; Duseja, Ajay; Jafri, Wasim; Devarbhavi, Harshad; Eapen, CE; Goel, Ashish; Sood, Ajit; Jia, Jinping; Duan, Zhongping; Chen, Y.

doi:10.1111/liv.13443

Cited by 29 publications

(43 citation statements)

References 20 publications

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“…A higher prevalence of structural AKI has been reported for patients with ACLF. In a large cohort study from the AARC database, the concept of PIRO (defined as predisposition, infection/inflammation, response, organ failure) was used for creating a predictive model for understanding the pathophysiology of kidney dysfunction in patients with ACLF [109]. Together, the components of PIRO reflect the role of key factors, which result in development, and progression of AKI in patients with ACLF.…”

Section: Renal Failurementioning

confidence: 99%

“…The PIRO, which is a composite score, derived from the AARC database accurately predicted in patients with ACLF, highlighting the prognostic significance of kidney dysfunction in these patients. The PIRO score can predict the development of AKI within first 15 days of diagnosis of ACLF and may help in stratification for additional therapeutic interventions [109].…”

Section: Renal Failurementioning

confidence: 99%

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Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

et al. 2019

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the “APASL ACLF Research Consortium (AARC)” was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the ‘Golden Therapeutic Window’, extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here.

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Section: Renal Failurementioning

confidence: 99%

Section: Renal Failurementioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

et al. 2019

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“…In the current issue of Liver International, Maiwall and collaborators try to give further insight regarding the relevance of renal failure in the evaluation of ACLF patients . In the study, the authors aimed to develop a predicting model of acute kidney injury [AKI] in patients with ACLF as defined according to APASL criteria.…”

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confidence: 99%

“…In the current issue of Liver International, Maiwall and collaborators try to give further insight regarding the relevance of renal failure in the evaluation of ACLF patients. 9 In the study, the authors aimed to Indeed, the median [interquartile range] baseline Scr of patients who developed AKI within the first week from admission was 2.53 mg/dL [1.88-3.9 mg/dL], meaning that more than 75% of that subgroup of patients presented a profound renal impairment at admission. This is especially relevant because based on this definition authors could not distinguish between patients with chronic kidney disease who develop superimposed AKI or those with "community acquired" AKI, from patients who really fulfilled the definition of AKI, the main endpoint of the study.…”

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confidence: 99%

Acute on chronic liver failure: Are we ready to predict?

Ibáñez‐Samaniego

Bañares

2017

Liver International

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The characterisation of the concept of acute on chronic liver failure[ACLF] is probably one of the most exciting changes occurred in the field of hepatology in the past 3-5 years. The main features associated to this newly defined syndrome are its frequency [one-third of patients admitted to the hospital due to acutely decompensated cirrhosis], its severity [up to 78% 30-day mortality] and its pathogenic association to systemic inflammation.

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“…However, its predictive value in HBV-ACLF patients has yet to be confirmed. Given that age, INR, total bilirubin (TBIL), and creatinine are reported to be independent risk factors for predicting outcome in patients with liver failure [5,9,15], it is possible that ABIC score might be a potential prognostic model for patients with HBV-ACLF.…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Age-Bilirubin-International Normalized Ratio-Creatinine Score in Short-Term Survival of Acute-on-Chronic Hepatitis B Liver Failure

Chen

Zheng

Cai

et al. 2018

Cell Physiol Biochem

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Background/Aims: The age-bilirubin-international normalized ratio-creatinine (ABIC) score, which is a predictive model commonly used for alcoholic hepatitis, has not yet been studied in acute-on-chronic hepatitis B liver failure (HBV-ACLF). We aimed to investigate the predictive value of the ABIC score in patients with HBV-ACLF. Methods: This retrospective study involved 398 patients diagnosed with HBV-ACLF, who were divided into a training cohort of 305 patients and a validation cohort of 93 patients. Univariate and multivariate Cox regression models were used to determine risk factors for mortality. Area under the receiver operating characteristic curve (AUC) was calculated to estimate and compare the predictive values of different prognostic scores. Results: The ABIC score was significantly higher in the death group of the training cohort than in its survival group. Independent risk factors for mortality identified by multivariate Cox analysis included blood urea nitrogen, ABIC score, and Chronic Liver Failure Consortium Organ Failure (CLIF-C OF) score. For predicting 1- and 3-month mortality, AUC was higher for the ABIC score than for the Model for End-stage Liver Diseases (MELD) score (0.732 vs. 0.653, P < 0.05, 0.695 vs. 0.619, P < 0.05, respectively), CLIF-C OF score (0.693, P=0.353, 0.656, P=0.341, respectively), and Child-Pugh score (0.675, P=0.189, 0.656, P=0.300, Respectively). Patients with ABIC score > 9.44 had reduced 1- and 3-month survival rates. Conclusion: ABIC score is superior to MELD score in predicting short-term survival in HBV-ACLF patients. ABIC score > 9.44 predicts high short-term mortality risk in HBV-ACLF patients.

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

Abstract: 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.

Cited by 29 publications

References 20 publications

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Acute on chronic liver failure: Are we ready to predict?

Predictive Value of Age-Bilirubin-International Normalized Ratio-Creatinine Score in Short-Term Survival of Acute-on-Chronic Hepatitis B Liver Failure

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