Discussion
hepatitis B, TB, death, chronic kidney disease, hepatorenal syndrome, decompensated hepatitis B cirrhosis, cirrhosis, anemia, liver cirrhosis, alcohol-related cirrhosis, renal injury, decompensated cirrhosis, liver diseases
HEPATITIS B, VIRUS, DECOMPENSATED CIRRHOSIS, HEPATORENAL SYNDROME, CIRRHOSIS, COMPLICATION, LIVER DISEASE, ANEMIA, LIVER CIRRHOSIS, ORGANIC DISEASE, LIVER DISEASES, COMPLICATIONS
The prevalence of hepatitis B virus is a major public health problem not only in China but also worldwide. For patients with decompensated cirrhosis, hepatorenal syndrome is one of the serious complications. Therefore, early prediction and diagnosis of HRS can reduce the incidence [HRS is a serious complication of renal function damage without obvious organic disease in the kidney that may occur in patients with advanced severe liver disease, and the incidence rate of HRS in patients with cirrhosis is about 19.2%. In this study, we tried to establish a diagnostic model to predict HRS by retrospective analysis of clinical data of HRS patients. It should be pointed out that the laboratory indicators included in this study are all indicators that must be tested on admission, so some unconventional indicators related to renal injury are not included, such as Urine electronics and urine β 2-MG concentrations. Janicko et al. included urine sodium in a study on predictors of alcohol-related cirrhosis with hepatorenal syndrome, but the difference was not statistically significant [In addition, some biomarkers whose predictive value for HRS has not been clearly defined are also excluded from the model established in this study, such as serum cystatin C (CysC) [In this study, we constructed a noninvasive model of early HRS in patients with decompensated hepatitis B cirrhosis and a specific algorithm (Fig. Application of our model for the early prediction of decompensated hepatitis B cirrhosis patients with HRS symptomatic treatment algorithmThe following might explain the clinical significance and predictive value of Hb, TB and Cr for the early prediction of HRS. First, anemia is common in patients with advanced liver disease. When the MELD score increases, hemoglobin levels decrease [Second, total bilirubin is divided into direct bilirubin and indirect bilirubin. Most human bilirubin comes from hemoglobin released from aging red blood cells. Indirect bilirubin is transported to the liver through blood and generates direct bilirubin through the action of hepatocytes. The occurrence of liver diseases will affect this process. Serum total bilirubin is an index reflecting the reserve function of the liver. The worse the reserve function of the liver, the more likely patients are to have HRS. Therefore, patients with liver cirrhosis who have obvious liver function damage should be aware of the potential occurrence of HRS. Studies have found that serum total bilirubin concentration may be a new risk factor for chronic kidney disease [Finally, most guidelines define HRS based on serum creatinine. Adding serum creatinine to the MELD score can reflect the prognostic impact of renal function, predict the likelihood of death within 3 months and rank American patients for organ transplants [Our prediction model has unique characteristics. It uses only conventional serum markers, which are inexpensive and easy to obtain. Therefore, it would be useful in most medical institutions. At the same time, the diagnostic efficiency (AUC = 0.968) was better than that of the MELD score (AUC = 0.896) [This study also has several limitations. First, the sample size is relatively small. Before its clinical application, large cohort studies should be conducted. Second, the model was built in a training group, and another group in the same center was randomly selected for validation. Third, serum-specific test indicators can improve the effectiveness of the model. Nonetheless, we believe that external validation of multicenter studies can enhance the effectiveness of the model. However, our main goal is to build a noninvasive model for use in most medical facilities. Many hospitals have no access to data on special test indexes in serum, which limits clinical application.