Short-term mortality in patients with cirrhosis of the liver and acute kidney injury: A prospective observational study
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ORIGINAL ARTICLE
Short-term mortality in patients with cirrhosis of the liver and acute kidney injury: A prospective observational study Uday Kumar 1 & Ravikant Kumar 2 Amarendra Kumar 2
&
Sanjeev Kumar Jha 2 & Ashish Kumar Jha 2 & Vishwa Mohan Dayal 2 &
Received: 15 July 2019 / Accepted: 3 August 2020 # Indian Society of Gastroenterology 2020
Abstract Introduction Renal failure is a common and severe complication of cirrhosis and confers poor prognosis. Serum creatinine is the most practical biomarker of renal function. Serum creatinine estimation in cirrhosis of the liver is affected by decreased formation, increased tubular secretion, increased volume of distribution, and interference by elevated bilirubin. Studies on the prognosis of cirrhotic patients using creatinine kinetics as a definition of acute kidney injury (AKI) proposed by the International Ascites Club are limited. Methods In this single-center prospective observational study, decompensated cirrhotics with AKI defined by the International Ascites Club as the rise of serum creatinine ≥ 0.3 mg/dL within 48 h of admission or increase of serum creatinine ≥ 50% from stable baseline creatinine over the previous 3 months were followed and assessed for the development of complications during hospital course and in-hospital and 30-day mortality. Results AKI developed in 142 out of 499 (28.45%) patients with cirrhosis. Twenty patients were excluded. The most common etiology of cirrhosis was alcohol (n = 64, 52%), and ascites was present in 115 (94%) patients. Eighty-two (67.21%) patients presented with AKI at the time of admission. Thirty-day mortality was 46.72% (57/122 patients). Hepatorenal syndrome had the highest mortality followed by AKI related to infection. Presence of jaundice and hepatic encephalopathy (HE) was associated with poor survival with adjusted hazard ratio of 3.54 and 2.17, respectively. On bivariate logistic regression analysis, jaundice, HE, type of AKI, AKI stage at maximum creatinine, bilirubin, serum glutamic oxaloacetic transaminase (SGOT), international normalized ratio (INR), and ChildTurcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores were predictors of mortality (p < 0.05). Sensitivity, specificity, and accuracy of MELD > 29 and CTP score > 11 were 75.44%, 82%, and 78.70% and 66.67%, 81.54%, and 74.60%, respectively for predicting 30-day mortality. Conclusion Development of AKI as defined by the International Ascites Club in cirrhosis confers high short-term mortality. Jaundice, HE, AKI stage, creatinine at enrollment, bilirubin, CTP, and MELD score were the predictors of mortality.
Keywords Chronic liver disease . Complications . Creatinine kinetics . Decompensated cirrhosis . International Ascites Club . Prognosis . Renal failure . Survival
Introduction * Ravikant Kumar [email protected] 1
Patna Medical College, Patna 800 001, India
2
Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna 800 014, India
Renal failure is one of the most common and severe
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