Risk Factors and Outcomes of Acute Kidney Injury in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Am J Med Sci. 2017 May;353(5):452-458. doi: 10.1016/j.amjms.2017.03.005. Epub 2017 Mar 21.


Background: Acute kidney injury (AKI) is common in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF); however, few studies concerning the risk factors and recovery patterns of renal function have been published.

Materials and methods: A retrospective analysis of 150 patients with HBV-ACLF was performed. The occurrence, risk factors and functional recovery of AKI among patients with HBV-ACLF were investigated.

Results: A total of 90 patients (60%) with HBV-ACLF developed AKI. Patients with AKI had higher creatine kinase (P = 0.004), total bilirubin (P = 0.039), HBV viral load (P = 0.044), serum creatine (P < 0.001) and model for end-stage liver disease (MELD) score (P < 0.001) values and a higher proportion of hepatic encephalopathy (P = 0.032) and spontaneous bacterial peritonitis (SBP) (P = 0.042) than patients without AKI. Logistic regression analysis illustrated that SBP (odds ratio = 6.214, P = 0.012) and MELD score (odds ratio = 1.097, P = 0.006) were risk factors for the development of AKI. A subgroup analysis of recovery patterns in renal function showed that patients with a severe AKI stage had worse outcomes (P = 0.007). The proportion of patients who experienced a complete recovery was higher in survivors than in the overall AKI populations (P = 0.004). Follow-up studies showed that the no-AKI group had a higher transplant-free survival rate than the AKI group at day 90 (80.0% versus 26.7%, respectively, P < 0.001). The survival rate among patients with AKI Stage 1 was higher than that of patients with AKI Stage 2 and patients with AKI Stage 3 (P < 0.001).

Conclusions: AKI is common in patients with HBV-ACLF. The SBP and MELD score have some prognosis value for patients with AKI. AKI and its stages affect the 90-day transplant-free mortality rate. It is important to focus on exploring the early recognition of AKI and early intervention of those risk factors in individuals with HBV-ACLF.

Keywords: Acute kidney injury; Acute-on-chronic liver failure; Critical care outcomes; Prognosis; Risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / virology
  • Acute-On-Chronic Liver Failure / virology*
  • Adult
  • China / epidemiology
  • Female
  • Hepatitis B / complications*
  • Hepatitis B virus / physiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Risk Factors
  • Severity of Illness Index
  • Survival Rate