Description

Maiwall et al reported a PIRO (predisposition, injury, response, organ failure) model for acute kidney injury in a patient with acute-on-chronic liver failure (ACLF). The authors are from multiple institutions from around the world.


Patient selection: acute-on-chronic liver failure

 

Outcome: acute kidney injury (AKI) - one or more of the following: rise in serum creatinine > 0.3 mg/dL within 48 hours; >= 50% increase from admission value at day 7; initiation of renal replacement therapy

 

The authors developed both a nomogram and reported a logistic regression formula.

 

Parameters:

(1) serum BUN in mg/dL

(2) serum creatinine in mg/dL

(3) circulatory failure

(4) nephrotoxicity (as injury)

(5) systemic inflammatory response syndrome (SIRS, as response)

(6) serum potassium in mmol/L

(7) serum total bilirubin in mg/dL

 

points for BUN =

= MIN(100,0.2857*(BUN))

 

Parameter

Finding

Points

serum creatinine

< 2 mg/dL

0

 

>= 2 mg/dL

52

circulatory failure

no

0

 

yes

14.8

nephrotoxicity

no

0

 

yes

27.2

SIRS

no

0

 

yes

8

serum potassium

< 3 mmol/L

0

 

3 to 4.99 mmol/L

11

 

>= 5 mmol/L

17.3

serum total bilirubin

< 12 mg/dL

0

 

12 to 29.9 mg/dL

4.4

 

>= 30 mg/dL

10.5

 

total score =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 230

• The higher the score the greater the risk of acute kidney injury.

 

X =

= (0.087001 * (score)) - 5.4643

 

probability of AKI =

= 1 / (1 + EXP((-1) * X))

 

Performance:

• The area under the ROC curve in the development set was 0.95.


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