ALBI Grade Is Associated with Clinical Outcomes of Critically Ill Patients with AKI: A Cohort Study with Cox Regression and Propensity Score Matching

Background

The albumin-bilirubin (ALBI) grade has surfaced as a viable substitute for assessing liver functional reserve in individuals afflicted with hepatocellular carcinoma (HCC). ALBI grade also demonstrates the capacity to stratify distinct patient subcohorts bearing disparate prognostic implications in not only HCC but also other inflammatory diseases like acute pancreatitis. However, the association between ALBI grade and clinical outcomes of acute kidney injury (AKI) remains mysterious.

Methods

The dataset was sourced from the Multiparameter Intelligent Monitoring in Intensive Care Database IV (MIMIC-IV) version 2.0. ALBI grade was calculated in a nomogram utilizing albumin and bilirubin. In order to ascertain the connection between ALBI grades and clinical outcomes of patients with AKI, Cox proportional hazards regression analysis was employed with in-hospital, 30- and 90-day mortality as end points, respectively. The Kaplan-Meier (K-M) curve was employed to gauge the cumulative incidence of mortality based on various ALBI grades. To explore potential nonlinear relationships, the Restricted Cubic Spline (RCS) approach was adopted. Furthermore, a subgroup analysis was conducted to validate the durability of the correlation between ALBI grade and in-hospital mortality. Furthermore, equilibrium of confounding variables was also achieved through the application of propensity score matching (PSM).

Results

The study encompassed a total of 12,518 patients (ALBI grade 1 : 2878, grade 2 : 6708, and grade 3 : 2932). Patients with heightened ALBI grades displayed a significant correlation with increased mortality in both univariate and various multivariate Cox regression models. RCS depicted a predominantly linear relationship. The robustness of the correlation was also affirmed across multifarious subpopulations through subgroup analysis. The association still remains after PSM.

Conclusion

Elevated ALBI grade was associated with worse clinical outcomes of critically ill patients with AKI.

Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: a focus on its controversies and screening of patients most likely to benefit

Surgical resection (SR) is recommended as a radical procedure in the treatment of hepatocellular carcinoma (HCC). However, postoperative recurrence negatively affects the long-term efficacy of SR, and preoperative adjuvant therapy has therefore become a research hotspot. Some clinicians adopt transcatheter arterial chemoembolization (TACE) as a preoperative adjuvant therapy in patients undergoing SR to increase the resection rate, reduce tumor recurrence, and improve the prognosis. However, the findings of the most relevant studies remain controversial. Some studies have confirmed that preoperative TACE cannot improve the long-term survival rate of patients with HCC and might even negatively affect the resection rate. Which factors influence the efficacy of preoperative TACE combined with SR is a topic worthy of investigation. In this review, existing clinical studies were analyzed with a particular focus on several topics: screening of the subgroups of patients most likely to benefit from preoperative TACE, exploration of the optimal treatment regimen of preoperative TACE, and determination of the extent of tumor necrosis as the deciding prognostic factor.

Effect of acute kidney injury on the patients with hepatocellular carcinoma undergoing transarterial chemoembolization

The purpose of this study was to investigate the effect of acute kidney injury (AKI) on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). A total of 347 HCC patients with Child-Pugh class A and pre-TACE serum creatinine (SCr) ≤1.5 mg/dL undergoing TACE as an initial therapy 2000-2014 were analyzed. Overall survival with related risk factors including AKI was investigated. We assessed AKI based on the International Club of Ascites (ICA)-AKI criteria. The mean age was 60.9 years. Of 347 patients, death was observed in 109 patients (31.4%). The mean SCr levels at pre-TACE, one day, two months, and four months after TACE were 0.9, 0.9, 0.9, and 1.1 mg/dL, respectively. The AKI within four months after TACE developed in 37 patients (11%). The AKI stages were non-AKI in 310 (89%), stage 1 in 10 (3%), stage 2 in 10 (3%), and stage 3 in 17 patients (5%). Multivariable analysis showed that the risk factors for overall survival were serum albumin ≤3.5 g/dL (hazard ratio [HR] 1.58, p = 0.027), BCLC stage B (HR 2.07, p = 0.008), BCLC stage C (HR 3.96, p<0.001), bilobar tumor location (HR 1.66, p = 0.022), AKI stage 1 (HR 6.09, p<0.001), AKI stage 2 (HR 8.51, p<0.001), and AKI stage 3 (HR 17.64, p<0.001). AKI is a crucial prognostic factor for overall survival in HCC patients undergoing TACE. The assessment of AKI based on the ICA-AKI criteria can facilitate evaluation of the prognosis of HCC patients undergoing TACE.

Albumin-bilirubin score is associated with in-hospital mortality in critically ill patients with acute pancreatitis

OBJECTIVE

Acute pancreatitis is one of the most common causes of inpatient care among gastrointestinal conditions. Few easy and commodious biomarkers are used in clinical practice to predict the prognosis of patients with acute pancreatitis. This study was aimed at examining the association of albumin-bilirubin (ALBI) score and in-hospital mortality in critically ill patients with acute pancreatitis.

METHODS

We enrolled all critically ill patients with acute pancreatitis retrospectively in Monitoring in Intensive Care Database III database. Clinical data and demographic information were collected for each patient in our study. Multivariate logistic regression models and smooth curve fitting were used to determine whether ALBI score could be an independent indicator for the prognosis of patients with acute pancreatitis. Predictive performance of ALBI was assessed by receiver operating characteristic analysis.

RESULTS

A total of 284 patients with acute pancreatitis met the inclusion criteria, and 35 patients died in hospital. The ALBI in nonsurvived group was much higher than survived group (-1.0 vs. -1.5; P < 0.001). The association of ALBI and in-hospital mortality was almost linear by smooth curve fitting (P < 0.001) and positive associations were observed between ALBI and RDW and WBC in patients with acute pancreatitis. Multivariate logistic regression indicated ALBI could be independent risk factors to predict the prognosis of patients with acute pancreatitis (odds ratios = 1.60; P = 0.02). The area under curve of in-hospital mortality prediction (0.86; P < 0.001) were superior to Sequential Organ Failure Assessment (SOFA) score (0.72; P < 0.001), Simplified Acute Physiology Score II (SAPS-II) (0.71; P < 0.001), Acute Physiology and Chronic Health Evaluation II (APACHE-II, 0.83; P < 0.001), Ranson score (0.75; P < 0.001) and Glasgow score (0.72; P < 0.001).

CONCLUSION

ALBI could be a useful marker of in-hospital mortality for patients with acute pancreatitis, which was better than SOFA, SAPS-II, APACHE-II, Ranson score and Glasgow score in our study.