Acute Kidney Injury Is an Early Predictor of Mortality for Patients With Alcoholic Hepatitis (original) (raw)
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Journal of Clinical and Translational Hepatology
Background and Aims: Acute kidney injury (AKI) occurs commonly in patients with acute-on-chronic liver failure (ACLF). However, there are scant data regarding the impact of AKI on survival in ACLF. We performed a prospective study to evaluate the impact of AKI on survival in ACLF. Methods: This study was conducted in ACLF patients hospitalized in the Gastroenterology Department of Sriram Chandra Bhanja Medical College (India) between October 2016 and February 2018. Demographic, clinical and laboratory parameters were recorded, and outcomes were compared between patients with and without AKI and between patients with persistent AKI and AKI reversal at 48 h. Results: We screened 439 chronic liver disease patients as per the Asian Pacific Association for the Study of the Liver criteria and found that 113 (25.7%) of them had ACLF and 78 (69%) of them had AKI as per the Acute Kidney Injury Network criteria. ACLF patients with AKI had reduced 28-day survival (44.9% vs. 74.3%; p = 0.004) and 90-day survival (25.6% vs. 51.4%; p = 0.007), in comparison to ACLF patients without AKI. However, when comparison was made between AKI reverters and AKI persisters at 48 h, survival was comparable for both at 28 days and 90 days. Further, about one-tenth of ACLF patients with AKI died within 48 h of hospitalization. Conclusions: Over two-thirds of ACLF patients had AKI. Although ACLF itself is a predictor of reduced survival, a very small increase in serum creatinine further worsens survival. Importantly, AKI at admission is a better predictor of early mortality in ACLF patients since recovery from AKI at 48 h does not improve survival.
AKI persistence at 48 h predicts mortality in patients with acute on chronic liver failure
Hepatology international, 2017
Management of acute kidney injury (AKI) in cirrhotics has undergone a paradigm change. We evaluated the impact of AKI persistence at 48 h on outcome in patients with acute on chronic liver failure (ACLF). Consecutive patients with ACLF (n = 373) were prospectively followed. AKI was defined as increase in serum creatinine of 0.3 mg/dl or 1.5- to 2-fold from baseline. Persistent AKI was defined as nonresponsive AKI at 48 h with respect to admission serum creatinine. AKI at admission was present in 177 (47.5 %) patients. At 48 h, 73 % patients had persistent AKI and 27 % had responsive AKI. High Model for End-Stage Liver Disease (MELD) (≥26) [p, odds ratio (OR), 95 % confidence interval (CI)] [<0.001, 3.65 (2.1-3.67)], systemic inflammatory response syndrome (SIRS) [0.03, 1.6 (1.02-21.6)], and age (≥42 years) [0.03, 1.84 (1.19-2.85)] were significant predictors of AKI persistence. Persistent AKI was associated with significantly higher in-hospital mortality [p < 0.001, hazard rat...
Gastroenterology, 2019
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.
Brazilian Journal of Nephrology, 2020
Introduction: Acute kidney injury (AKI) is a recurrent complication in the intensive care unit (ICU) and is associated with negative outcomes. Objective: To investigate factors associated with mortality in critically ill AKI patients in a South Brazilian ICU. Methods: The study was observational retrospective involving AKI patients admitted to the ICU between January 2011 and December 2016 of at least 18 years old upon admission and who remained in the ICU at least 48 hours. Comparisons between selected characteristics of survivor and non-survivor groups were done using univariate analysis; multivariate logistic regression was applied to determine factors associated with patient mortality. Results: Of 838 eligible patients, 613 participated in the study. Men represented the majority (61.2%) of the patients, the median age was 53 years, and the global mortality rate was 39.6% (n= 243). Non-recovery of renal function after AKI (OR= 92.7 [38.43 - 223.62]; p <0.001), major surgery-as...
JGH open, 2019
Background and Aim: Acute kidney injury (AKI) commonly occurs in patients with chronic liver disease (CLD). As per the International Club of Ascites, AKI is classified into three stages; stage 1 has recently been divided into subgroups 1A and 1B. We performed a prospective study to validate the association between subgrouping and outcome. Methods: This study was conducted using decompensated cirrhosis (DC) patients hospitalized in the Gastroenterology ward between August 2016 and May 2018. Demographic, clinical, and laboratory parameters were compared between AKI 1A and AKI 1B patients. The duration of hospitalization and outcome were compared. Results: A total of 528 subjects were enrolled; 296 (56.1%) had AKI, and of them, 61.48% (n = 182) had stage 1, 20.95% (n = 62) had stage 2, and 17.57% (n = 52) had stage 3 AKI. Of the enrolled patients, 100 (54.94%) had early (AKI 1A) and 82 (45.06%) had late stage 1 AKI (AKI 1B). Patients with AKI 1B had higher total leucocyte count, total bilirubin, serum urea, serum creatinine (SCr), model for endstage liver disease (MELD), MELD-Na + , and child-turcotte-pugh (CTP) score and decreased serum albumin than AKI 1A. The prevalence of hepatorenal syndrome (HRS), acute on chronic liver failure (ACLF) were higher in AKI 1B patients, and they had a prolonged hospital stay compared to AKI 1A patients. Furthermore, AKI 1B patients had significantly lower survival both at 28 days and 90 days. Conclusion: Our study validates the subclassification of stage 1 AKI. Patients with AKI 1B more often progress to higher AKI stages with significantly lower 28-day and 90-day survival rates. Results justify subclassification and suggest the need for early intervention. The small increase in SCr should be viewed with caution in AKI stage 1A.
Journal of Clinical and Experimental Hepatology, 2020
Background: The occurrence of acute kidney injury (AKI) in acute-on-chronic liver failure (ACLF) negatively impacts the survival of patients. There are scant data on the impact of serum urea on outcomes in these patients. We performed this study to evaluate the relationship between admission serum urea and the survival in patients with ACLF and AKI. Methods: A prospective study was conducted on patients with ACLF (as per Asian Pacific Association for the Study of the Liver criteria) and AKI (as per Acute Kidney Injury Network criteria) hospitalized in the gastroenterology ward between October 2016 and May 2018. Demographic, clinical and laboratory parameters were recorded, and outcomes were compared in patients with respect to the admission serum urea level. Results: A total of 103 of 143 hospitalized patients with ACLF had AKI and were included as study subjects. The discrimination ability between survivors and the deceased was similar for serum urea levels (area under the receiver operating characteristic curve [AUROC] [95% confidence interval {CI}]: 28 days survival, 0.76 [0.67-0.85]; 90 days survival, 0.81 [0.72-0.91]) and serum creatinine levels (AUROC [95% CI]: 28 days survival, 0.75 [0.66-0.84]; 90 days survival: 0.77 [0.67-0.88]) in patients with ACLF and AKI. However, on multivariate analysis, admission serum urea (not serum creatinine) was an independent predictor of mortality in these patients both at 28 days (p = 0.001, adjusted hazard ratio [
Prognostic Significance of The New Criteria for Acute Kidney Injury in Cirrhosis
Annals of hepatology, 2018
New criteria for acute kidney injury (AKI) in cirrhosis have been proposed, but its prognostic significance is unclear. This study aims to evaluate the prognostic significance of the AKI criteria in cirrhotic patients hospitalized for acute decompensation. This is a prospective cohort study. AKI was defined as an increase in creatinine (Cr) levels ≥ 0.3 mg/dL in 48 h or ≥ 50% of the basal value in the last 7d. AKI was divided into stages 1 (elevation: < 2x basal), 2 (2 or 3x), and 3 (> 3x). In this study, 227 patients aged 53.9 ± 11.5 years were included, of whom 37% had AKI (28% AKI1, 5% AKI2, and 4% AKI3). Thirty percent of the patients died or were transplanted within 90 days from causes related to the presence of ascites at hospital admission and higher values of Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) scores, but not to the presence of AKI. In a regression analysis conducted to assess the effect of the final Cr level in patients with AKI, 90-...