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

doi:10.4329/wjr.v16.i6.221

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World Journal of Radiology

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Observational Study

World J Radiol. Jun 28, 2024; 16(6): 221-231
Published online Jun 28, 2024. doi: 10.4329/wjr.v16.i6.221

Table 1 Baseline clinical characteristics of the study population, n = 200

Parameter	Frequency
Age in yr, mean ± SD	49.08 ± 11.68
Male, n (%)	159 (79.5)
Etiology of cirrhosis, n (%)
Alcohol	78 (39.0)
NAFLD	49 (24.5)
Viral	37 (18.5)
Others	36 (18.0)
CTP Class, n (%)
A	23 (11.5)
B	66 (33.0)
C	111 (55.5)
Cirrhosis duration in mo, median (IQR)	6.00 (2.001-4.40)
CTP score, mean ± SD	9.59 ± 2.27
MELD-Na score, median	21 (7-40) ± 7.19
BMI, mean ± SD	19.79 ± 3.05
Comorbidity, n (%)
None	121 (60.5)
Type 2 DM	34 (17.0)
HTN	44 (22.0)
Hypothyroidism	1 (0.5)
Duration of type 2 DM in mo, mean ± SD	23.94 ± 13.3
Duration of HTN in mo, mean ± SD	24.09 ± 11.84
ACLF presence, n (%)	27 (13.5)
ACLF grade among n = 27, n (%)
I	6 (22.2)
II	10 (37.0)
III	11 (40.7)
Abdominal circumference in cm, mean ± SD	95.64 ± 16.28
Ascites among n = 153, n (%)
Grade II	70 (45.7)
Grade III	83 (54.3)
Diuretic responsive	90 (59.0)
Diuretic resistant	63 (41.0)
MAP in mmHg, mean ± SD	76.16 ± 5.39
Heart rate in bpm, median (IQR)	80.00 (60.00-130.00)

ACLF: Acute-on-chronic liver failure; CTP: Child Turcotte Pugh; DM: Diabetes mellitus; HTN: Hypertension; IQR: Interquartile range; MAP: Mean arterial pressure; MELD: Model for end-stage liver disease; NAFLD: Non-alcoholic fatty liver disease; SD: Standard deviation.

Table 2 Baseline clinical characteristics according to the type of acute kidney injury, n = 200

Parameter	PRA, n = 29	ATN-AKI, n = 18	HRS-AKI, n = 82	No-AKI, n = 71	^aP value
Age in yr, mean ± SD	53.9 ± 10.1	43.3 ± 10.8	50.7 ± 11.3	46.8 ± 12.0	0.003
Sex as male/female	26/3	16/2	64/18	53/18	0.268
Etiology of cirrhosis: Alcohol/NAFLD/viral/others	15/9/4/1	14/1/2/1	25/21/25/11	24/18/17/12	0.012
Hepatic encephalopathy, n (%)	4 (13.7)	1 (5.5)	5 (6.1)	7 (9.8)	0.568
GI bleed, n (%)	1 (3.4)	0 (0.0)	2 (2.4)	55 (69.6)	< 0.001
Sepsis, n (%)	2 (6.9)	12 (66.6)	49 (59.7)	0 (0.0)	< 0.001
Shock, n (%)	0 (0.0)	18 (100.0)	0 (0.0)	0 (0.0)	< 0.001
ACLF, n (%)	0 (0.0)	13 (72.2)	14 (17.0)	0 (0.0)	< 0.001
CTP score, mean ± SD	9.83 ± 1.61	11.89 ± 1.08	10.44 ± 1.87	7.93 ± 2.08	< 0.001
MELD-Na score, mean ± SD	21.50 ± 5.54	29.60 ± 7.19	22.10 ± 7.10	17.70 ± 5.70	< 0.001
Stage of AKI: Stage 1/stage 2/stage 3	16/13/0	3/5/10	32/29/21	0/0/0	< 0.001
Ascites: No/diuretic responsive/refractory	1/26/2	0/7/11	0/34/48	46/23/2	< 0.001
Hemoglobin in g/dL, mean ± SD	7.78 ± 1.58	8.79 ± 2.27	8.87 ± 1.75	7.97 ± 2.54	0.010
Total leukocyte count as cells/mm³, mean ± SD	7410 ± 5750	13760 ± 6760	7290 ± 3990	5640 ± 3290	< 0.001
Platelet count as cells/mm³, mean ± SD	89700 ± 31600	97100 ± 27600	98000 ± 32700	98200 ± 38400	0.654
Bilirubin in mg/dL, mean ± SD	1.76 ± 1.13	10.11 ± 8.70	3.62 ± 3.35	2.20 ± 1.82	< 0.001
ALT in U/L, mean ± SD	40.5 ± 23.1	53.1 ± 24.6	57.1 ± 77.9	38.6 ± 28.9	0.078
AST in U/L, mean ± SD	64.3 ± 41.2	130.7 ± 59.1	109.4 ± 63.2	68.4 ± 66.9	< 0.001
INR, mean ± SD	1.64 ± 0.42	2.43 ± 0.66	1.83 ± 0.57	1.57 ± 0.45	< 0.001
Albumin, mean ± SD	2.80 ± 0.41	2.48 ± 0.34	2.62 ± 0.43	2.98 ± 0.47	< 0.001
Urea in mg/dL, mean ± SD	90.10 ± 20.24	33.40 ± 6.85	44.3 ± 29.68	44.0 ± 26.31	< 0.001
Creatinine in mg/dL on Day 1, mean ± SD	1.68 ± 0.191	0.911 ± 0.264	1.335 ± 0.778	0.940 ± 0.276	< 0.001
Creatinine in mg/dL on Day 3, mean ± SD	1.53 ± 0.315	3.10 ± 1.165	2.81 ± 1.537	0.975 ± 0.212	< 0.001
CRP in mg/L, mean ± SD	38.6 ± 28.1	42.2 ± 25.7	37.7 ± 32.7	23.4 ± 19.9	< 0.001
Serum sodium in mEq/L, mean ± SD	126 ± 23.52	128 ± 6.26	130 ± 6.66	133 ± 4.89	0.001
Serum potassium in mEq/L, mean ± SD	4.42 ± 0.611	4.35 ± 0.604	4.25 ± 0.668	4.14 ± 0.552	0.155
RRI, mean ± SD	0.63 ± 0.07	0.80 ± 0.02	0.73 ± 0.0	0.60 ± 0.07	< 0.001

^aP value: P < 0.05 was considered statistically significant between the groups. ACLF: Acute on chronic liver failure; AKI: Acute kidney injury; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ATN: Acute tubular necrosis; CRP: C-reactive protein; CTP: Child Turcotte Pugh; GI: Gastrointestinal; HRS: Hepatorenal syndrome; INR: International normalized ratio; MELD-Na: Model for end-stage liver disease-sodium; NAFLD: Non-alcoholic fatty liver disease; PRA: Prerenal AKI; RRI: Renal resistive index; SD: Standard deviation.

Table 3 Comparison of clinical parameters in patients with and without high RRI, n = 200

Parameters	High RRI, > 0.73, n = 82	Low RRI, ≤ 0.73, n = 118	^aP value
Age in yr, mean ± SD	47.98 ± 11.01	50.40 ± 12.37	0.810
Sex
Male, n (%)	69 (84.1)	90 (76.2)	0.170
Comorbidity, n (%)
Present	19 (23.2)	60 (50.8)	0.110
ACLF among n = 27	20 (24.3)	7 (5.9)	< 0.001
ACLF grade, n (%)
Grade I	5 (25)	1 (0.8)	0.002
Grade II	7 (35)	3 (2.5)
Grade III	8 (40)	3 (2.5)
AKI, n (%)	79 (96.3)	50 (42.4)	< 0.001
AKI stage among n = 129, n (%)
Stage I	27 (32.9)	24 (20.3)
Stage II	28 (34.1)	19 (16.1)
Stage III	24 (29.2)	7.0 (5.9)
AKI phenotype among n = 129, n (%)
ATN-AKI	17 (94.4)	1 (0.8)	< 0.001
HRS-AKI	59 (72)	23 (19.4)
PRA	3 (10.3)	26 (22.0)
BMI in kg/m²	19.70 ± 3.06	19.87 ± 3.06	0.169
Abdominal circumference in cm	102.98 ± 10.2	90.54 ± 17.6	< 0.001
Duration of cirrhosis in mo	10.96 ± 11.5	10.55 ± 12.18	0.574
Etiology, n (%)
Alcohol	31 (37.8)	47 (39.8)	0.907
NAFLD	19 (23.2)	30 (25.4)
Viral	22 (26.8)	15 (12.7)
Others	10 (12.2)	26 (22.1)
CTP class, n (%)
A	1 (1.2)	22 (18.6)	< 0.001
B	17 (20.7)	49 (41.5)
C	64 (78.1)	47 (39.8)
MELD-Na Score	23 (7-33)	19 (7-28)	< 0.001
Ascites among n = 153, n (%)
Grade-II	26 (32.5)	44 (37.2.3)	< 0.001
Grade-III	54 (67.5)	29 (24.5)	< 0.001
MAP in mmHg	73.50 ± 6.77	78.2 ± 2.61	< 0.001
Heart rate	90.8 ± 16.55	80.8 ± 7.35	< 0.001

^aP value: P < 0.05 was considered statistically significant between the groups. ACLF: Acute on chronic liver failure; AKI: Acute kidney injury; ATN: Acute tubular necrosis; BMI: Body mass index; CTP: Child Turcotte Pugh; HRS: Hepatorenal syndrome; MAP: Mean arterial pressure; MELD-Na: Model for end-stage liver disease-sodium; NAFLD: Non-alcoholic fatty liver disease; PRA: Prerenal AKI; RRI: Renal resistive index; SD: Standard deviation.

Table 4 Discriminatory performance of renal resistive index for different phenotypes of acute kidney injury

Parameters	AUROC curve	RRI cut-off	Sensitivity	Specificity	PPV	NPV
ATN-AKI vs non-ATN AKI	94%	0.77	89%	96%	80%	98%
ATN-AKI vs HRS-AKI	94%	0.77	89%	98%	94%	97%
ATN-AKI vs PRA	93%	0.73	100%	89%	85%	100%
HRS-AKI vs non HRS-AKI	56%	0.72	94%	55%	78%	84%
HRS-AKI vs PRA	87%	0.71	95%	89%	96%	86%
PRA vs no-AKI	59%	0.59	76%	45%	36%	81%

AKI: Acute kidney injury; ATN: Acute tubular necrosis; AUROC: Area under receiver operating characteristic curve; HRS: Hepatorenal syndrome; NPV: Negative predictive value; PPV: Positive predictive value; PRA: Prerenal AKI; RRI: Renal resistive index.

Citation: Surya H, Kumar R, Priyadarshi RN, Surya Prakash S, Kumar S. Renal resistive index measurements by ultrasound in patients with liver cirrhosis: Magnitude and associations with renal dysfunction. World J Radiol 2024; 16(6): 221-231
URL: https://www.wjgnet.com/1949-8470/full/v16/i6/221.htm
DOI: https://dx.doi.org/10.4329/wjr.v16.i6.221