Renal resistive index measurements by ultrasound in patients with liver cirrhosis: Magnitude and associations with renal dysfunction.

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING World journal of radiology Pub Date : 2024-06-28 DOI:10.4329/wjr.v16.i6.221
Himanshu Surya, Ramesh Kumar, Rajeev Nayan Priyadarshi, Sabbu Surya Prakash, Sudhir Kumar
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Abstract

Background: The hemodynamic alterations seen in liver cirrhosis lead to renal vasoconstriction, ultimately causing acute kidney injury (AKI). The renal resistive index (RRI) is the most common Doppler ultrasound variable for measuring intrarenal vascular resistance.

Aim: To evaluate the association of the RRI with AKI in patients with liver cirrhosis and to identify risk factors for high RRI.

Methods: This was a prospective observational study, where RRI was measured using Doppler ultrasound in 200 consecutive hospitalized patients with cirrhosis. The association of RRI with AKI was studied. The receiver operating characteristic (ROC) curve analysis was utilized to determine discriminatory cut-offs of RRI for various AKI phenotypes. Multivariate analysis was conducted to determine the predictors of high RRI.

Results: The mean patient age was 49.08 ± 11.68 years, with the majority (79.5%) being male; the predominant etiology of cirrhosis was alcohol (39%). The mean RRI for the study cohort was 0.68 ± 0.09, showing a progressive increase with higher Child-Pugh class of cirrhosis. Overall, AKI was present in 129 (64.5%) patients. The mean RRI was significantly higher in patients with AKI compared to those without it (0.72 ± 0.06 vs 0.60 ± 0.08; P < 0.001). A total of 82 patients (41%) had hepatorenal syndrome (HRS)-AKI, 29 (22.4%) had prerenal AKI (PRA), and 18 (13.9%) had acute tubular necrosis (ATN)-AKI. The mean RRI was significantly higher in the ATN-AKI (0.80 ± 0.02) and HRS-AKI (0.73 ± 0.03) groups than in the PRA (0.63 ± 0.07) and non-AKI (0.60 ± 0.07) groups. RRI demonstrated excellent discriminatory ability in distinguishing ATN-AKI from non-ATN-AKI (area under ROC curve: 93.9%). AKI emerged as an independent predictor of high RRI (adjusted odds ratio [OR]: 11.52), and high RRI independently predicted mortality among AKI patients (adjusted OR: 3.18).

Conclusion: In cirrhosis patients, RRI exhibited a significant association with AKI, effectively differentiated between AKI phenotypes, and predicted AKI mortality.

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通过超声波测量肝硬化患者的肾阻力指数:肝硬化患者的肾阻力指数测量:幅度及与肾功能障碍的关系。
背景:肝硬化患者的血流动力学改变会导致肾血管收缩,最终引起急性肾损伤(AKI)。肾脏阻力指数(RRI)是测量肾内血管阻力最常用的多普勒超声变量。目的:评估肝硬化患者的肾脏阻力指数与 AKI 的关系,并确定高肾脏阻力指数的风险因素:这是一项前瞻性观察研究,使用多普勒超声测量了连续住院的 200 名肝硬化患者的 RRI。研究了 RRI 与 AKI 的关系。利用接收者操作特征(ROC)曲线分析确定了各种 AKI 表型的 RRI 鉴别临界值。进行了多变量分析以确定高 RRI 的预测因素:患者平均年龄为(49.08 ± 11.68)岁,大多数(79.5%)为男性;肝硬化的主要病因是酒精(39%)。研究队列的平均 RRI 为 0.68 ± 0.09,显示随着肝硬化 Child-Pugh 分级的升高而逐渐升高。总体而言,129 例(64.5%)患者出现了 AKI。与无 AKI 患者相比,有 AKI 患者的平均 RRI 明显更高(0.72 ± 0.06 vs 0.60 ± 0.08;P < 0.001)。共有 82 名患者(41%)患有肝肾综合征(HRS)-AKI,29 名患者(22.4%)患有肾前性 AKI(PRA),18 名患者(13.9%)患有急性肾小管坏死(ATN)-AKI。ATN-AKI 组(0.80 ± 0.02)和 HRS-AKI 组(0.73 ± 0.03)的平均 RRI 明显高于 PRA 组(0.63 ± 0.07)和非 AKI 组(0.60 ± 0.07)。RRI 在区分 ATN-AKI 和非 ATN-AKI 方面表现出卓越的鉴别能力(ROC 曲线下面积:93.9%)。AKI是高RRI的独立预测因素(调整后比值比[OR]:11.52),高RRI可独立预测AKI患者的死亡率(调整后比值比:3.18):肝硬化患者的 RRI 与 AKI 有显著关联,能有效区分 AKI 表型并预测 AKI 死亡率。
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来源期刊
World journal of radiology
World journal of radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
自引率
8.00%
发文量
35
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