title: Development of predisposition, injury, response, organ failure model for predicting acute kidney injury in acute on chronic liver failure.
abstract: There is limited data on predictors of acute kidney injury in acute on chronic liver failure. We developed a PIRO model (Predisposition, Injury, Response, Organ failure) for predicting acute kidney injury in a multicentric cohort of acute on chronic liver failure patients.
  
  
  
  Data of 2360 patients from APASL-ACLF Research Consortium (AARC) was analysed. Multivariate logistic regression model (PIRO score) was developed from a derivation cohort (n=1363) which was validated in another prospective multicentric cohort of acute on chronic liver failure patients (n=997).
  
  
  
  Factors significant for P component were serum creatinine[(≥2 mg/dL)OR 4.52, 95% CI (3.67-5.30)], bilirubin [(<12 mg/dL,OR 1) vs (12-30 mg/dL,OR 1.45, 95% 1.1-2.63) vs (≥30 mg/dL,OR 2.6, 95% CI 1.3-5.2)], serum potassium [(<3 mmol/LOR-1) vs (3-4.9 mmol/L,OR 2.7, 95% CI 1.05-1.97) vs (≥5 mmol/L,OR 4.34, 95% CI 1.67-11.3)] and blood urea (OR 3.73, 95% CI 2.5-5.5); for I component nephrotoxic medications (OR-9.86, 95% CI 3.2-30.8); for R component,Systemic Inflammatory Response Syndrome,(OR-2.14, 95% CI 1.4-3.3); for O component, Circulatory failure (OR-3.5, 95% CI 2.2-5.5). The PIRO score predicted acute kidney injury with C-index of 0.95 and 0.96 in the derivation and validation cohort. The increasing PIRO score was also associated with mortality (P<.001) in both the derivation and validation cohorts.
  
  
  
  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.
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Maiwall
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Shiv Kumar
authors.identifier: 0000-0002-0544-5610
authors.initials: SK
authors.lastname: Sarin
authors.affiliation: Department of Clinical Hematology, Command Hospital [Eastern Command], Kolkata, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Jain
authors.affiliation: Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Guresh
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Ajeet Singh
authors.initials: AS
authors.lastname: Bhadoria
authors.affiliation: UMR_S1149, Center for Research in Inflammation (CRI), Inserm and Paris Diderot University, Paris, France.|DHU Unity, Liver unit, Beaujon hospital, APHP, Clichy, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Chandan Kumar
authors.initials: CK
authors.lastname: Kedarisetty
authors.affiliation: Department of Gastroenterology, Ziauddin University Hospital, Karachi, Pakistan.
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.affiliation: Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research, Mumbai, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Amarapurkar
authors.affiliation: Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Ankit
authors.initials: A
authors.lastname: Bhardwaj
authors.affiliation: Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Chhagan
authors.initials: C
authors.lastname: Bihari
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Amna Subhan
authors.initials: AS
authors.lastname: Butt
authors.affiliation: Department of Surgery, Division of Hepatobiliary and Pancreatic surgery, and Liver Transplantation, The University of Hong Kong, Hong Kong, China.
authors.forename: Albert
authors.initials: A
authors.lastname: Chan
authors.affiliation: Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Yogesh Kumar
authors.initials: YK
authors.lastname: Chawla
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Chowdhury
authors.affiliation: Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: RadhaKrishan
authors.initials: R
authors.lastname: Dhiman
authors.affiliation: Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Abdul Kadir
authors.initials: AK
authors.lastname: Dokmeci
authors.affiliation: Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia.
authors.forename: Hasmik
authors.initials: H
authors.lastname: Ghazinyan
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Saeed Sadiq
authors.initials: SS
authors.lastname: Hamid
authors.affiliation: Center for Liver and Digestive Diseases, Hallym University Chuncheon Sacred Heart Hospital, Gangwon-Do, Korea.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Piyawat
authors.initials: P
authors.lastname: Komolmit
authors.affiliation: Department of Hepatology, The Institute of Translational Hepatology, Beijing 302 Hospital, Beijing, China.
authors.forename: George K
authors.initials: GK
authors.lastname: Lau
authors.affiliation: Department of Medicine, National University Health System, Singapore, Singapore.
authors.forename: Guan Huei
authors.initials: GH
authors.lastname: Lee
authors.affiliation: Division of Hepatology, University of Indonesia, Jakarta, Indonesia.
authors.forename: Laurentius A
authors.initials: LA
authors.lastname: Lesmana
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Kapil
authors.initials: K
authors.lastname: Jamwal
authors.affiliation: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.lastname: Mamun-Al-Mahtab
authors.affiliation: Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Rajendra Prasad
authors.initials: RP
authors.lastname: Mathur
authors.affiliation: Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Suman Lata
authors.initials: SL
authors.lastname: Nayak
authors.affiliation: Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Ning
authors.affiliation: Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Viniyendra
authors.initials: V
authors.lastname: Pamecha
authors.affiliation: Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines.
authors.forename: Diana
authors.initials: D
authors.lastname: Alcantara-Payawal
authors.affiliation: Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.forename: Salimur
authors.initials: S
authors.lastname: Rahman
authors.affiliation: Institute of Liver diseases and Transplantation, Global Health city, Chennai, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Saraswat
authors.affiliation: Department of Hepatology, Global Hospitals, Mumbai, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt.
authors.forename: Gamal
authors.initials: G
authors.lastname: Shiha
authors.affiliation: Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Sharma
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Department of Hepatology Selayang Hospital, Selangor, Malaysia.
authors.forename: Soek Siam
authors.initials: SS
authors.lastname: Tan
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Shivendra Singh
authors.initials: SS
authors.lastname: Chandel
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Chitranshu
authors.initials: C
authors.lastname: Vashishtha
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Zeeshan A
authors.initials: ZA
authors.lastname: Wani
authors.affiliation: Department of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Man-Fung
authors.identifier: 0000-0001-7985-7725
authors.initials: MF
authors.lastname: Yuen
authors.affiliation: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
authors.affiliation: Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Duseja
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Wasim
authors.initials: W
authors.lastname: Jafri
authors.affiliation: Department of Gastroenterology, St.John's Medical College and Hospital, Bangalore, India.
authors.forename: Harshad
authors.initials: H
authors.lastname: Devarbhavi
authors.affiliation: Department of Gastroenterology and Hepatology, CMC, Vellore, India.
authors.forename: C E
authors.initials: CE
authors.lastname: Eapen
authors.affiliation: Department of Gastroenterology, Rome, NY, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Goel
authors.affiliation: Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, India.
authors.forename: Ajit
authors.initials: A
authors.lastname: Sood
authors.affiliation: Department of Gastroenterology, Liver Research Center, Beijing, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Ji
authors.affiliation: Department of Gastroenterology, Nanjing First Hospital, Nanjing, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Duan
authors.affiliation: Department of Gastroenterology, East Brunswick, NJ, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D065290:Acute-On-Chronic Liver Failure / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D000328:Adult; D001208:Asia; D015415:Biomarkers / Q000097:blood; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049451:Nomograms; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers
keywords: 
  PIRO
  ; Multiple organ failure; acute kidney injury; acute on chronic liver failure; liver failure