Kidney failure was defined as an increase of serum creatinine > 2 mg/dl or requirement of renal replacement therapy. Factors
considered for univariate analysis for Predisposition included patient demographics, severity and etiology of underlying liver disease, baseline biochemical parameters, presence of ascites,comorbidities including chronic kidney disease; for Injury- diuretic use, nephrotoxicity, bacterial infections, variceal bleed; for Response-components of systemic inflammatory response syndrome and for Organ failure-extrarenal organ failures i.e. cerebral, circulatory and respiratory defined according to CLIF-SOFA score. Results: Of 1365 patients with ACLF (age 44 ±12.9 years, 83% males) with MELD INCB024360 purchase score of 32.6 ± 9.4, 29% developed kidney
failure. Factors significant (p,OR, 95% CI) on multivariate analysis for P component were high baseline MELD (&30) (<0.001, 1.72, 1.34-2.2) and low serum sodium (<130mEq/l) (0.002, 1.4, 1.14-1.9); for I component, bacterial infections (0.02, 1.4, 1.04-1.96); for R component, leucocytosis (0.03, 1.3, 1.021.71); for O component, circulatory failure (<0.0001, 4.6, 3.2-6.7) and cerebral failure (<0.001,2.7, 2.1-3.6). The combination of these four components into a single-value predictor of kidney failure in the combined PIRO model identified circulatory failure (OR 5.8, 95% CI 3.1-11.1) and cerebral failure (OR 2.1, 95% CI 1.2-3.7) as the most significant predictors. Amongst all organ failures, presence of circulatory failure at baseline was
the most Midostaurin purchase significant predictor of mortality however (OR 1.8, 95% CI 1.1-3.3). Conclusions: The PIRO model could be a novel approach to identify and stratify ACLF patients at risk of kidney failure. Kidney failure is commonly associated with presence of extra-renal organ failures at baseline amongst which circulatory failure predicts mortality independent of both renal and other organ failures. Disclosures: George K. Lau – Consulting: Roche, Novartis, Roche, Novartis, Roche, Novartis, Roche, Novartis Qin Ning – Advisory Committees or Review Panels: ROCHE, NOVARTIS, BMS, MSD, GSK; Consulting: ROCHE, NOVARTIS, BMS, MSD, GSK; Grant/Research Support: ROCHE, NOVARTIS, BMS; Speaking and Teaching: ROCHE, NOVAR-TIS, BMS, MSD, GSK Diana A. Payawal – Advisory Committees or Review Panels: United Laboratories; Consulting: Takeda Pharmaceutical; Speaking and Teaching: Fatima Medical University Hospital Soek Siam Tan – Advisory Committees or Review Panels: Abbvie Osamu Yokosuka – Grant/Research Support: Chugai, Taiho, Bristol Myers The following people have nothing to disclose: Rakhi Maiwall, Shiv K. Sarin, Chandan K. Kedarisetty, Richard Moreau, Suman Kumar, Zaigham Abbas, Deepak N.