Su1533 – Admission Serum Urea is a Better Predictor of Mortality Than Serum Creatinine in Patients with Acute on Chronic Liver Failure (ACLF) (original) (raw)

BACKGROUND & AIMS: Occurrence of acute kidney injury [AKI] in patients with Acute on chronic liver failure (ACLF) negatively impacts their survival. Traditionally, only serum creatinine level is used to assess AKI and survival in ACLF, and there is scant data on the relation of serum urea with outcome in these patients. We performed a prospective study to evaluate the correlation of serum urea with survival in ACLF patients especially in comparison to serum creatinine. METHODS: This study was conducted in ACLF patients hospitalised in Gastroenterology Department of SCB Medical College in India between October 2016 and August 2018. Demographic, clinical, laboratory parameters were recorded and outcome compared between patients with ACLF, with special emphasis on AKI and admission serum urea and creatinine levels. Results: Of 576 hospitalised decompensated cirrhotic patients, 26.7% (n=154) had ACLF [APASL criteria], and 110(71.4%) of them had AKI [AKIN criteria]. Alcohol was the commonest underlying cause of CLD (78.6%); while continued alcohol intake (54.5%) was the commonest precipitant of ACLF. On multivariate analysis, we found admission serum urea (not serum creatinine) as an independent predictor of mortality in ACLF both at 28 days (p=.007, AHR 1.009, 95% CI 1.003-1.016) and 90 days (p=.004, AHR 1.010, 95% CI 1.003-1.016). Besides admission serum urea (not serum creatinine) was also found to be independent predictor of mortality in ACLF with AKI patients both at 28 days (p=0.013, AHR 1.009, 95%CI 1.002-1.016) and 90 days (p=.007, AHR 1.010, 95%CI 1.003-1.017). The discrimination ability between survivors and deceased was similar for serum urea and creatinine both in ACLF patients [serum urea, AUROC 28 days(.74), 90 days(.75); 95%CI], [serum creatinine, AUROC 28 days(.75), 90 days(.76); 95%CI]; and patients with ACLF and AKI [serum urea, AUROC 28 days(.74), 90 days(.70); 95%CI] and [creatinine, AUROC 28 days(.75), 90 days(.75); 95%CI]. However, at serum urea cut off level of 41mg/dl derived from AUROC, significant differences were found in duration of hospitalisation (4days vs 7days; p<.001), and survival both at 28 days (p<.001) and 90 days (p<.001) in ACLF patients with and without AKI. 97.3 %(n=72) ACLF patients with serum urea ≥41mg/dl had AKI and 2.7 %(n=2) patients were without AKI at hospitalisation. Conclusions: In our institution, about a fourth of decompensated cirrhotic patients had ACLF and two thirds of them were associated with AKI. Though the discrimination ability between survivors and deceased both at 28 days and 90 days are similar for serum urea and creatinine levels, admission serum urea was found to be a better predictor of mortality than serum creatinine in all ACLF patients irrespective of AKI. Hence serum creatinine may be replaced by serum urea, as a predictor of mortality in ACLF patients.