Admission Serum Urea is a Better Predictor of Mortality than Creatinine in Patients With Acute-On-Chronic Liver Failure and Acute Kidney Injury

Khatua, Chitta Ranjan; Sahu, Swagatika; Meher, Dinesh; Nath, Gautam; Mohapatra, Archisman; Thakur, Bhaskar

doi:10.1016/j.jceh.2020.12.005

Cited by 4 publications

(2 citation statements)

References 21 publications

(18 reference statements)

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“…In patients with acute kidney injury, it is possible to find fluid overload from the initial stages [79], which means that in severe cases that do not respond to fluid restriction and the use of diuretics, renal replacement therapy is indicated [80,81]. For this reason, the association between high urea values and higher mortality in patients with acute kidney injury [82,83] could explain our findings. However, the presence of high BAR values in patients without the severe disease can be explained by the units of measurement used or the dilution of urea values caused by fluid overload, similarly to what happens with the serum creatinine [84,85].…”

Section: Discussionmentioning

confidence: 70%

Fibrinogen-to-Albumin Ratio and Blood Urea Nitrogen-to-Albumin Ratio in COVID-19 Patients: A Systematic Review and Meta-Analysis

et al. 2022

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Fibrinogen-to-albumin ratio (FAR) and blood urea nitrogen-to-albumin ratio (BAR) are inflammatory biomarkers that have been associated with clinical outcomes of multiple diseases. The objective of this study is to evaluate the association of these biomarkers with the severity and mortality of COVID-19 patients. A systematic search was performed in five databases. Observational studies that reported the association between FAR and BAR values with the severity and mortality of COVID-19 patients were included. Random-effects models were used for meta-analyses, and effects were expressed as Odds Ratio (OR) and their 95% confidence intervals (CI). Publication bias was assessed using the Begg test, while the quality assessment was assessed using the Newcastle Ottawa Scale. A total of 21 studies (n = 7949) were included. High FAR values were associated with a higher risk of severity (OR: 2.41; 95% CI 1.41–4.12; p < 0.001) and mortality (OR: 2.05; 95% CI 1.66–2.54; p < 0.001). High BAR values were associated with higher risk of mortality (OR: 4.63; 95% CI 2.11–10.15; p < 0.001). However, no statistically significant association was found between BAR values and the risk of severity (OR: 1.16; 95% CI 0.83–1.63; p = 0.38). High FAR and BAR values were associated with poor clinical outcomes.

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Section: Discussionmentioning

confidence: 70%

Fibrinogen-to-Albumin Ratio and Blood Urea Nitrogen-to-Albumin Ratio in COVID-19 Patients: A Systematic Review and Meta-Analysis

et al. 2022

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“…Furthermore, acute kidney injury is an important predictor of early mortality in patients ACLF 38 . A study has indicated that serum urea is a more accurate predictor of mortality than serum creatinine in ACLF patients with acute kidney injury 39 . In critically ill patients, an elevated BUN was associated with increased mortality independent of serum creatinine 40 .…”

Section: Discussionmentioning

confidence: 99%

A novel prognostic model to predict mortality in patients with acute-on-chronic liver failure in intensive care unit

Lin,

Chen,

Tsai

et al. 2024

Intern Emerg Med

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BackgroundAcute on chronic liver failure (ACLF) implies high short-term mortality rates and usually requires intensive care unit (ICU) admission. Proper prognosing these patients is crucial for early referral for liver transplantation. The superiority of CLIF-C ACLF score in Asian patients with ACLF admitted to an ICU remains inconclusive when compared to other scoring systems. The purpose of the study is (i) to compare the predictive performance of original MELD, MELD-Lactate, CLIF-C ACLF, CLIF-C ACLF-Lactate, and APACHE-II scores for short-term mortality assessment. (ii) to build and validate a novel scoring system and to compare its predictive performance to that of the original ve scores. Methods 265 consecutive cirrhotic patients with ACLF who were admitted to our ICU were enrolled. The prognostic values for mortality were assessed by ROC analysis. A novel model was developed and internally validated using 5-fold cross-validation. ResultsAlcohol abuse was identi ed as the primary etiology of cirrhosis. The AUROC of the ve prognostic scores in predicting one-month mortality prediction were not signi cantly superior to each other in predicting one-month and three-month mortality. The newly developed prognostic model, incorporating age, A-a gradient, BUN, total bilirubin level, INR, and HE grades, exhibited signi cantly improved performance in predicting one-month and three-month mortality with AUROC of 0.863 and 0.829, respectively, as compared to the original ve prognostic scores. ConclusionsThe novel ACLF model is superior to the original ve scores in predicting short-term mortality for ACLF patients admitted to an ICU. Further rigorous validation is required.necessitating urgent liver transplantation (LT) 6,7 . Due to the short transplantation window, a rapid decision-making process is necessary 6,7 .Two important issues for a successful bridging to LT are accurate prognostication and prioritization of ACLF patients awaiting LT 6 . Therefore, it is essential to develop an accurate prognostic score to estimate the outcomes in ACLF patients and help guide clinicians in determining the appropriate treatment options according to the predicted outcomes 8 . Despite the development of several prognostic scoring systems for evaluating outcomes and organ dysfunction in ICU patients 9,10 , accurately predicting short-and long-term mortality remains a signi cant challenge 11 . The European Association for the Study of the Liver--Chronic Liver Failure (EASL-CLIF) Consortium developed the CLIF Consortium ACLF score (CLIF-C ACLFs) by simplifying the original CLIF-Sequential Organ Failure Assessment (SOFA) score based on CLIF-C organ failure (OF) scores, which demonstrated higher prognostic accuracy than the CLIF-SOFA, the Model for End-Stage Liver Disease (MELD), MELD-Na, and Child-Pugh (CP) scores 12 for ACLF patients. It was also externally validated in ACLF patients hospitalized in a single ICU 12 . The CLIF-C ACLF-D score was derived from the Predicting Acute-on-Chronic Liver Failure (PREDICT) study 13 . The newly de...

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An in-vivo interpretation for validating the ameliorative efficacy of green synthesized MnO2 nano-conjugate using Carica Papaya (Papaya) leaf extract against acute hepatic damage

Bhattacharjee

Bardhan

Ghosh

et al. 2021

Journal of Drug Delivery Science and Technology

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Admission Serum Urea is a Better Predictor of Mortality than Creatinine in Patients With Acute-On-Chronic Liver Failure and Acute Kidney Injury

Cited by 4 publications

References 21 publications

Fibrinogen-to-Albumin Ratio and Blood Urea Nitrogen-to-Albumin Ratio in COVID-19 Patients: A Systematic Review and Meta-Analysis

Fibrinogen-to-Albumin Ratio and Blood Urea Nitrogen-to-Albumin Ratio in COVID-19 Patients: A Systematic Review and Meta-Analysis

A novel prognostic model to predict mortality in patients with acute-on-chronic liver failure in intensive care unit

An in-vivo interpretation for validating the ameliorative efficacy of green synthesized MnO2 nano-conjugate using Carica Papaya (Papaya) leaf extract against acute hepatic damage

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