Update on hepatorenal Syndrome: Definition, Pathogenesis, and management

Habas, Elmukhtar; Ibrahim, Ayman R.; Moursi, Moaz O.; Shraim, Bara A.; Elgamal, Mohamed E.; Elzouki, Abdel-Naser

doi:10.1016/j.ajg.2022.01.005

Cited by 9 publications

(8 citation statements)

References 87 publications

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“…When TBIL rises, the dilation of splanchnic vasculature and the intense increase in renal artery tone lead to renal cortex ischemia and hypoperfusion. This is one of the contributing factors that lead to the development of hepatorenal syndrome [ 33 ]. Sepsis also play an important role in the model.…”

Section: Discussionmentioning

confidence: 99%

Machine learning-based prediction model of acute kidney injury in patients with acute respiratory distress syndrome

Wei,

Zhang,

Dong

et al. 2023

BMC Pulm Med

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Background Acute kidney injury (AKI) can make cases of acute respiratory distress syndrome (ARDS) more complex, and the combination of the two can significantly worsen the prognosis. Our objective is to utilize machine learning (ML) techniques to construct models that can promptly identify the risk of AKI in ARDS patients. Method We obtained data regarding ARDS patients from the Medical Information Mart for Intensive Care III (MIMIC-III) and MIMIC-IV databases. Within the MIMIC-III dataset, we developed 11 ML prediction models. By evaluating various metrics, we visualized the importance of its features using Shapley additive explanations (SHAP). We then created a more concise model using fewer variables, and optimized it using hyperparameter optimization (HPO). The model was validated using the MIMIC-IV dataset. Result A total of 928 ARDS patients without AKI were included in the analysis from the MIMIC-III dataset, and among them, 179 (19.3%) developed AKI after admission to the intensive care unit (ICU). In the MIMIC-IV dataset, there were 653 ARDS patients included in the analysis, and among them, 237 (36.3%) developed AKI. A total of 43 features were used to build the model. Among all models, eXtreme gradient boosting (XGBoost) performed the best. We used the top 10 features to build a compact model with an area under the curve (AUC) of 0.850, which improved to an AUC of 0.865 after the HPO. In extra validation set, XGBoost_HPO achieved an AUC of 0.854. The accuracy, sensitivity, specificity, positive prediction value (PPV), negative prediction value (NPV), and F1 score of the XGBoost_HPO model on the test set are 0.865, 0.813, 0.877, 0.578, 0.957 and 0.675, respectively. On extra validation set, they are 0.724, 0.789, 0.688, 0.590, 0.851, and 0.675, respectively. Conclusion ML algorithms, especially XGBoost, are reliable for predicting AKI in ARDS patients. The compact model maintains excellent predictive ability, and the web-based calculator improves clinical convenience. This provides valuable guidance in identifying AKI in ARDS, leading to improved patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Machine learning-based prediction model of acute kidney injury in patients with acute respiratory distress syndrome

Wei,

Zhang,

Dong

et al. 2023

BMC Pulm Med

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“…Patients with advanced liver cirrhosis are at risk for developing the functional acute kidney injury (AKI) known as hepatorenal syndrome (HRS), which is linked to renal vasoconstriction after splanchnic vasodilatation (12) . Several factors, including ascites, serum creatinine >2.5 mg/dL, serum albumin 2 g/dL, serum total bilirubin >2 mg/dL, and spontaneous bacterial peritonitis, have been studied as predictors for HRS in patients with severe liver cirrhosis (13) .…”

Section: Discussionmentioning

confidence: 99%

“…A case-control study that included a total of 40 subjects; 30 patients with advanced liver cirrhosis, subdivided into; Group 1: 20 decompensated cirrhotic patients with hepatorenal syndrome (12…”

Section: Patients and Methods Study Designmentioning

confidence: 99%

Serum Copeptin as a Predictor for Hepatorenal Syndrome in Advanced Liver Cirrhosis Patients: A Single-Center Study

Mahmoud¹,

Talaat²,

Sherif³

et al. 2022

The Egyptian Journal of Hospital Medicine

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Background: Hepatorenal syndrome (HRS) may result from decreased renal perfusion in advanced liver cirrhosis patients. Copeptin is co-secreted with the arginine vasopressin (AVP) and is increased in patients with decompensated liver cirrhosis, however, limited studies associated Copeptin with HRS.Objective: This study aimed to evaluate serum Copeptin as a predictor of HRS in advanced liver cirrhosis patients. Patients and Methods: A case-control study had been carried out on a total of 40 subjects divided into; Group 1: 20 decompensated cirrhotic patients with HRS, Group 2: 10 decompensated cirrhotic patients with normal kidney function, and Group 3: 10 healthy controls. The following had been made; history taking, clinical examination, laboratory investigations: complete blood picture, liver function tests, coagulation profile, serum sodium, and creatinine. Serum Copeptin was measured using an enzyme-linked immunosorbent assay (ELISA). Results: Serum Copeptin levels; mean ±SD in pmol/L were significantly increased in group 1 (HRS) (7.3±1.11) compared to group 2 (3.6±0.99) and group 3 (2.3±0.31) (P˂0.001). Serum Copeptin levels positively correlated with serum creatinine, prothrombin time, total bilirubin (P˂0.05), and negatively correlated with serum albumin (P˂0.05), and sodium (P˂0.001), with no correlation with other parameters. The receiver operating characteristic (ROC) curve for serum Copeptin validity as a predictor of HRS in advanced liver cirrhosis patients, at a cutoff of 3.99 pmol/L showed 95.1% sensitivity, 70.2% specificity, and 85.1% accuracy. Conclusion: Serum Copeptin may predict HRS in advanced liver cirrhosis with high sensitivity and specificity.

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“…Every year, FDA registers an increasing number of drugs belonging to this class. – Almost half of the existing peptide drugs are compounds with one or several S–S bridges. ,– The most well-known among them are analogues of the natural hormones somatostatin, oxytocin, and vasopressin: octreotide, atosiban, terlipressin, etc. , Over the past 7 years, 6 radiopharmaceuticals based on octreotide have been approved . Atosiban (“Tractocile”), desmopressin (DDAVP) (“Minirin”), and terlipressin (“Remestyp”, “Terlivaz”, and “Glypressin”) are now firmly established in clinical practice. – These drugs are structural analogues of oxytocin and Arg 8 /Lys 8 -vasopressin. Modifications of the native hormone structure, introduced in these peptides, are aimed at increasing their proteolytic stability and improving their pharmacokinetic characteristics. – …”

Section: Introductionmentioning

confidence: 99%

Formation of a Disulfide Bridge on the Resin during Solid-Phase Synthesis of Terlipressin: Influence of the Boc-Protected and Free N-Terminal Amino Group

Avdeev,

Ovchinnikov,

Medvedev

et al. 2023

Org. Process Res. Dev.

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An industry-ready approach for the synthesis of terlipressin is developed: the entire peptide chain assembly and subsequent disulfide bond closure are carried out on a polymeric carrier with a specific precaution for the protection of the Nterminal α-amino group. The effect of various factors on the purity of crude disulfide was studied, and the solid-phase cyclization process was optimized. The designed approach has high fidelity and reproducibility and is applicable for a large-scale peptide synthesis (we show it up to 15 g of the pure product). Using molecular modeling, we have found that the state of the N-terminal amino group (free or protected) has a significant influence on the ability of two cysteine side chains to reach each other, paving the way to a rational choice of protecting groups in peptide synthesis.

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Update on hepatorenal Syndrome: Definition, Pathogenesis, and management

Cited by 9 publications

References 87 publications

Machine learning-based prediction model of acute kidney injury in patients with acute respiratory distress syndrome

Machine learning-based prediction model of acute kidney injury in patients with acute respiratory distress syndrome

Serum Copeptin as a Predictor for Hepatorenal Syndrome in Advanced Liver Cirrhosis Patients: A Single-Center Study

Formation of a Disulfide Bridge on the Resin during Solid-Phase Synthesis of Terlipressin: Influence of the Boc-Protected and Free N-Terminal Amino Group

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