Gender-Specific Differences in Baseline, Peak, and Delta Serum Creatinine: The NACSELD Experience

Jacqueline G. O’Leary, Florence Wong, K. Rajender Reddy, Guadalupe Garcia-Tsao, Patrick S. Kamath, Scott W. Biggins, Michael B. Fallon, Ram M. Subramanian, B. Maliakkal, Leroy Thacker, Jasmohan S. Bajaj

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Women have lower serum creatinine values than men for similar renal function. Aims: We aimed to determine the differential effect of baseline, peak, and delta creatinine between genders on outcomes in infected hospitalized cirrhotic patients. Methods: North American Consortium for the Study of End-Stage Liver Disease is a 15-center consortium of tertiary care hepatology centers prospectively enrolling infected cirrhotic inpatients. Baseline, peak, and delta creatinine during hospitalization were compared between genders, and their impact on overall survival, transplant-free survival, probability of transplantation, and need for renal replacement therapy (RRT) was analyzed. Results: In total, 532 patients with cirrhosis (males = 59% median admission MELD = 20) had significantly lower median baseline (1.07 vs. 1.30 mg/dL, p < 0.0001) and peak creatinine (1.47 vs. 1.59 mg/dL, p = 0.024) in women than men during hospitalization for an infection, but both genders had similar delta creatinine levels (0.30 vs. 0.30 mg/dL, p = 0.957). Thirty-day mortality was similar between genders. RRT was not used more often in women (19 vs. 12%, p = 0.050), and women were 1.8 times more likely than men to receive RRT at the same creatinine (p = 0.028). Both peak and delta creatinine significantly predicted 6-month overall and transplant-free survival (p < 0.0001), but the probability of liver transplantation was affected by the interaction between gender and both peak and delta creatinine. Conclusions: Infected hospitalized cirrhotic women are significantly more likely than men to receive RRT at similar creatinine levels. Gender-specific differences in baseline, peak, and delta creatinine need further investigation to determine whether women need acute kidney injury treatment at lower creatinine thresholds than men.

Original languageEnglish (US)
Pages (from-to)768-776
Number of pages9
JournalDigestive Diseases and Sciences
Volume62
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Creatinine
Serum
Renal Replacement Therapy
Survival
Hospitalization
Transplants
End Stage Liver Disease
Gastroenterology
Acute Kidney Injury
Tertiary Care Centers
Liver Transplantation
Inpatients
Fibrosis
Transplantation
Kidney
Mortality
Infection

Keywords

  • Acute kidney injury
  • Female
  • Gender
  • Liver transplant
  • Renal function

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Gender-Specific Differences in Baseline, Peak, and Delta Serum Creatinine : The NACSELD Experience. / O’Leary, Jacqueline G.; Wong, Florence; Reddy, K. Rajender; Garcia-Tsao, Guadalupe; Kamath, Patrick S.; Biggins, Scott W.; Fallon, Michael B.; Subramanian, Ram M.; Maliakkal, B.; Thacker, Leroy; Bajaj, Jasmohan S.

In: Digestive Diseases and Sciences, Vol. 62, No. 3, 01.03.2017, p. 768-776.

Research output: Contribution to journalArticle

O’Leary, JG, Wong, F, Reddy, KR, Garcia-Tsao, G, Kamath, PS, Biggins, SW, Fallon, MB, Subramanian, RM, Maliakkal, B, Thacker, L & Bajaj, JS 2017, 'Gender-Specific Differences in Baseline, Peak, and Delta Serum Creatinine: The NACSELD Experience', Digestive Diseases and Sciences, vol. 62, no. 3, pp. 768-776. https://doi.org/10.1007/s10620-016-4416-7
O’Leary, Jacqueline G. ; Wong, Florence ; Reddy, K. Rajender ; Garcia-Tsao, Guadalupe ; Kamath, Patrick S. ; Biggins, Scott W. ; Fallon, Michael B. ; Subramanian, Ram M. ; Maliakkal, B. ; Thacker, Leroy ; Bajaj, Jasmohan S. / Gender-Specific Differences in Baseline, Peak, and Delta Serum Creatinine : The NACSELD Experience. In: Digestive Diseases and Sciences. 2017 ; Vol. 62, No. 3. pp. 768-776.
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abstract = "Background: Women have lower serum creatinine values than men for similar renal function. Aims: We aimed to determine the differential effect of baseline, peak, and delta creatinine between genders on outcomes in infected hospitalized cirrhotic patients. Methods: North American Consortium for the Study of End-Stage Liver Disease is a 15-center consortium of tertiary care hepatology centers prospectively enrolling infected cirrhotic inpatients. Baseline, peak, and delta creatinine during hospitalization were compared between genders, and their impact on overall survival, transplant-free survival, probability of transplantation, and need for renal replacement therapy (RRT) was analyzed. Results: In total, 532 patients with cirrhosis (males = 59{\%} median admission MELD = 20) had significantly lower median baseline (1.07 vs. 1.30 mg/dL, p < 0.0001) and peak creatinine (1.47 vs. 1.59 mg/dL, p = 0.024) in women than men during hospitalization for an infection, but both genders had similar delta creatinine levels (0.30 vs. 0.30 mg/dL, p = 0.957). Thirty-day mortality was similar between genders. RRT was not used more often in women (19 vs. 12{\%}, p = 0.050), and women were 1.8 times more likely than men to receive RRT at the same creatinine (p = 0.028). Both peak and delta creatinine significantly predicted 6-month overall and transplant-free survival (p < 0.0001), but the probability of liver transplantation was affected by the interaction between gender and both peak and delta creatinine. Conclusions: Infected hospitalized cirrhotic women are significantly more likely than men to receive RRT at similar creatinine levels. Gender-specific differences in baseline, peak, and delta creatinine need further investigation to determine whether women need acute kidney injury treatment at lower creatinine thresholds than men.",
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AU - Garcia-Tsao, Guadalupe

AU - Kamath, Patrick S.

AU - Biggins, Scott W.

AU - Fallon, Michael B.

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