Acute kidney injury in severe alcohol-associated hepatitis treated with anakinra plus zinc or prednisone.

We characterize the clinical factors and potential mechanisms associated with AKI development in that trial.

我们描述了与该试验中急性肾损伤（AKI）发展相关的临床因素和潜在机制。

approach_and_results

Data from 147 participants in a multicenter randomized clinical trial (74 A+Z, 73 PRED) were analyzed.

分析了多中心随机临床试验中147名参与者的数据（74名A+Z组，73名PRED组）

AKI, AKI phenotypes, and kidney injury biomarkers were compared between participants who did/did not develop AKI in the 2 treatment arms.

比较了两治疗组中发展与未发展急性肾损伤（AKI）的参与者之间的AKI、AKI表型和肾脏损伤生物标志物。

Multivariable competing risk analyses were performed to identify baseline risk factors for incident AKI, with death treated as a competing event.

进行了多变量竞争风险分析，以识别发生急性肾损伤（AKI）的基线风险因素，其中死亡被视为竞争事件。

Risk factors considered were age, sex, mean arterial pressure, white blood cell count, albumin, MELD, ascites, HE, and treatment arm.

考虑的风险因素包括年龄、性别、平均动脉压、白细胞计数、白蛋白、MELD评分、腹水、肝性脑病和治疗组别。

At baseline, no participants had AKI; 33% (n=49) developed AKI during follow-up.

基线时，没有参与者出现急性肾损伤（AKI）；随访期间有33%（n=49）的参与者发展为AKI。

AKI incidencewas higher in A+Z than in PRED (45% [n=33] versus 22% [n=16], p =0.001).

A+Z组的急性肾损伤（AKI）发生率高于PRED组（45% [n=33] 对比 22% [n=16]，p=0.001）。

AKI phenotypes were similar between the 2 treatment arms ( p =0.361), but peak AKI severity was greater in A+Z than PRED (stage 3 n=21 [63.6%] vs. n=8 [50.0%], p =0.035).

AKI表型在两个治疗组之间相似（p=0.361），但在A+Z组中AKI的严重程度峰值高于PRED组（3期n=21 [63.6%] vs. n=8 [50.0%]，p=0.035）。

At baseline, urine-neutrophil-gelatinase-associated lipocalin levels were similar between participants who developed AKI in both treatment arms ( p =0.319).

在基线时，发展为AKI的两组参与者之间的尿液中性粒细胞明胶酶相关脂质运载蛋白水平相似（p=0.319）。

However, day 7 and 14 urine-neutrophil-gelatinase-associated lipocalin levels were significantly elevated in participants treated with A+Z who developed AKI versus participants treated with PRED who developed AKI ( p =0.002 and 0.032, respectively).

然而，与接受PRED治疗后发展为急性肾损伤（AKI）的参与者相比，接受A+Z治疗后发展为AKI的参与者的第7天和第14天尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平显著升高（p值分别为0.002和0.032）。

On multivariable competing risk analysis, only A+Z was independently associated with incident AKI (subdistribution hazard ratio2.35, p =0.005).

在多变量竞争风险分析中，仅A+Z与新发AKI独立相关（亚分布风险比为2.35，p=0.005）。

Conclusions

AKI occurred more frequently and was more severe in participants treated with A+Z.

在使用A+Z治疗的参与者中，急性肾损伤（AKI）的发生更频繁且程度更严重。

A+Z-treated participants with AKI had higher urine-neutrophil-gelatinase-associated lipocalin, suggesting that A+Z maybe nephrotoxic in patients with severe alcohol-associated hepatitis.

A+Z治疗的急性肾损伤（AKI）患者尿液中的中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平更高，这暗示A+Z可能对严重酒精相关性肝炎患者具有肾毒性。