Effect of response at 48 hours of treatment of acute kidney injury on short-term prognosis of hepatitis B virus-associated acute-on-chronic liver failure

Objective To investigate whether response to the treatment of acute kidney injury ( AKI) is achieved at 48 hours and its effect on the 28-and 90-day prognosis of patients with hepatitis B virus-associated acute-on-chronic liver failure ( HBV-ACLF) and AKI.Methods A retrospective analysis was performed for the clinical data of 130 patients with HBV-ACLF and AKI who were hospitalized and treated in The Fifth Medical Center of Chinese PLA General Hospital from December 2012 to December 2014. According to the response to AKI treatment at 48 hours, the patients were divided into response group and non-response group, and the two groups were compared in terms of 28-and 90-day survival rates to screen out the independent influencing factors for 28-and 90-day prognosis. The t-test was used for comparison of normally distributed continuous data between two groups, and the Kolmogorov-Smirnov Z test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier survival curve was used to analyze survival rate, and the log-rank test was used for comparison. The Cox regression model was used to perform the univariate and multivariate analyses of influencing factors for prognosis. Results There were38 patients ( 29. 2%) in the response group and 92 patients ( 70. 8%) in the non-response group. The non-response group had significantly lower 28-and 90-day survival rates than the response group ( χ2= 16. 91, 23. 28, both P < 0. 01) . The Cox regression analysis showed that response to AKI treatment at 48 hours, age, serum creatinine, serum sodium, international normalized ratio, and hepatic encephalopathy were independent risk factors for 28- ( HR ( 95% CI) = 0. 271 ( 0. 116-0. 631) , 1. 024 ( 1. 001-1. 047) , 1. 002 ( 1. 000-1. 005) , 0. 948 ( 0. 904-0. 993) , 1. 451 ( 1. 139-1. 849, 1. 987 ( 1. 076-3. 670) , all P < 0. 05) and 90-day ( HR ( 95% CI) = 0. 292 ( 0. 151-0. 563) , 1. 024 ( 1. 004-1. 044) , 1. 002 ( 1. 000-1. 004) , 0. 946 ( 0. 909-0. 984) , 1. 473 ( 1. 180-1. 839) , 2. 135 ( 1. 232-3. 700) , all P < 0. 05) mortality in patients with HBV-ACLF and AKI. Conclusion Response to AKI treatment at 48 hours can significantly improve the short-term prognosis of patients with HBV-ACLF and AKI. Early diagnosis and active treatment of AKI should be strengthened in clinical practice to improve patient prognosis.