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. 2022 May 1;34(5):576-584.
doi: 10.1097/MEG.0000000000002314.

Mean arterial pressure drop is an independent risk factor of hepatorenal syndrome in patients with HBV-ACLF

Xingrong Zheng  1 , Yunwen Lian  1 , Peipei Wang  1 , Lihua Zheng  1 , Hewei Wu  1 , Jiaxin Lin  1 , Xiyao Chen  1 , Zhiliang Gao  1   2   3 , Liang Peng  1 , Chan Xie  1   2   3
Affiliations

Mean arterial pressure drop is an independent risk factor of hepatorenal syndrome in patients with HBV-ACLF

Xingrong Zheng et al. Eur J Gastroenterol Hepatol. .

Abstract

Background/aims: In patients with acute-on-chronic liver failure (ACLF), type 1 hepatorenal syndrome (HRS) is a critical organ failure complication that resulted in rapid mortality. There are no efficient parameters to predict HRS in hepatitis B virus (HBV)-related ACLF. To assess HBV-ACLF risk factors and evaluate the association between mean arterial pressures (MAP), HRS and survival in patients with HBV-ACLF.

Methods: A total of 420 ACLF patients were screened from June 2015 to June 2016, and 57 HBV-ACLF patients were included in the study. Clinical data and MAP measurements of these patients were collected. Multivariate analyses, Cox proportional hazards regression and receiver operator characteristic (ROC) curves were used to analyze.

Results: In a 30-day study period, 43 (75.44%) patients survived. Patients in the HRS group were older and had higher Model for End-Stage Liver Disease (MELD) scores than patients in the non-HRS group. A MAP drop of ≥9.5 mmHg was an independent predictor of HRS with a sensitivity and specificity of 92.86 and 69.77%, respectively. The baseline MELD score was also an independent risk factor of HRS. MAP drop (OR, 1.582; P = 0.000), prothrombin time, HRS, MELD and FIB were independent prognostic factors for 30-day mortality. The area under the ROC curve of MAP drop was 0.808 (P = 0.001).

Conclusion: A decrease in MAP was a valuable predictor of HRS in patients with HBV-related ACLF. MAP drop ≥9.5 mmHg may be useful for predicting patient prognosis and exploring new treatment measures in patients with HBV-related ACLF.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flow diagram of the patients screening and enrollment process.
Fig. 2.
Fig. 2.
Distribution of mean artery pressure (MAP) drops in different groups. (a) all patients; (b) Hepatorenal syndrome (HRS group); (c) non-HRS group.
Fig. 3.
Fig. 3.
Area under the receiver-operating characteristic (ROC) curves of different variables for predicting Hepatorenal syndrome (HRS) in patients with hepatitis B virus- Acute-on-chronic liver failure (HBV-ALCF). Mean artery pressure (MAP) drop (a), model for end-stage liver disease (MELD) scores (b), blood urea nitrogen (BUN) (c), fibrinogen (FIB) (d) and albumin (e).
See this image and copyright information in PMC

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