Prognosis of hospitalized patients with cirrhosis and acute kidney disease

Florence Wong, Guadalupe Garcia-Tsao, K. Rajender Reddy, Jacqueline G. O'Leary, Patrick S. Kamath, Puneeta Tandon, Jennifer C. Lai, Hugo E. Vargas, Scott W. Biggins, Michael B. Fallon, Paul J. Thuluvath, Benedict J. Maliakkal, Ram Subramanian, Leroy Thacker, Jasmohan S. Bajaj

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The prognosis of acute kidney disease (AKD), defined as a glomerular filtration rate of <60 ml/min/1.73 m2 or a rise in serum creatinine (sCr) of <50% for <3 months, is not clearly known. Aim: To study the prevalence, predictive factors and clinical outcomes in hospitalized cirrhotic patients with AKD. Methods: The North American Consortium for the Study of End-Stage Liver Disease prospectively enrolled hospitalized decompensated cirrhotic patients. Patients were separated into those with normal renal function (controls or C), AKD or stage 1 AKI as their worst renal dysfunction per International Club of Ascites definition and compared. Parameters assessed included demographics, laboratory data, haemodynamics, renal and patient outcomes. Results: 1244 patients with cirrhosis and ascites (C: 704 or 57%; AKD: 176 or 14%; stage 1 AKI: 364 or 29%) with similar demographics were enrolled. AKD patients had similar baseline sCr but higher hospital admission in the previous 6 months, and higher peak sCr, compared to controls, with their peak sCr being lower than that in stage 1 AKI patients (all P <.0001). The in-hospital and 30-day survival for AKD patients were intermediary between that for controls and stage 1 AKI patients (96% vs 91% vs 86%, P <.0001). The strongest predictors for AKD development while in hospital were the presence of a second infection (OR: 2.44) and diabetes (OR: 1.53). Conclusions: Patients with AKD had intermediate outcomes between stage 1 AKI and controls. AKD patients, especially those with diabetes and a second infection, need careful monitoring and prompt treatment for AKD to prevent negative outcomes.

Original languageEnglish (US)
Pages (from-to)896-904
Number of pages9
JournalLiver International
Volume42
Issue number4
DOIs
StatePublished - Apr 2022
Externally publishedYes

Keywords

  • diabetes
  • renal dysfunction
  • second infection
  • serum creatinine
  • survival

ASJC Scopus subject areas

  • Hepatology

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