New consensus definition of acute kidney injury accurately predicts 30-day mortality in patients with cirrhosis and infection.

Abstract

BACKGROUND & AIMS:

Participants at a consensus conference proposed defining cirrhosis-associated acute kidney injury (AKI) based on a >50% increase in serum creatinine level from the stable baseline value in <6 months or an increase of ≥ 0.3 mg/dL in <48 hours. We performed a prospective study to evaluate the ability of these criteria to predict mortality within 30 days of hospitalization among patients with cirrhosis and infection.

METHODS:

We followed up 337 patients with cirrhosis who were admitted to the hospital with an infection or developed an infection during hospitalization (56% men; 56 ± 10 years of age; Model for End-Stage Liver Disease [MELD] score, 20 ± 8) at 12 centers in North America. We compared data on 30-day mortality, length of stay in the hospital, and organ failure between patients with and without AKI.

RESULTS:

In total, based on the consensus criteria, 166 patients (49%) developed AKI during hospitalization. Patients who developed AKI were admitted with higher Child-Pugh scores than those who did not develop AKI (11.0 ± 2.1 vs 9.6 ± 2.1; P < .0001) as well as higher MELD scores (23 ± 8 vs 17 ± 7; P < .0001) and lower mean arterial pressure (81 ± 16 vs 85 ± 15 mm Hg; P < .01). Higher percentages of patients with AKI died within 30 days of hospitalization (34% vs 7%), were transferred to the intensive care unit (46% vs 20%), required ventilation (27% vs 6%), or went into shock (31% vs 8%); patients with AKI also had longer stays in the hospital (17.8 ± 19.8 vs 13.3 ± 31.8 days) (all P < .001). Of the AKI episodes, 56% were transient, 28% were persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%) compared with partial (40%) or complete recovery (15%) or those who did not develop AKI (7%; P < .0001).

CONCLUSIONS:

Among patients with cirrhosis, 30-day mortality is 10-fold higher among those with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure.

• Authors: Florence Wong, Jacqueline G O'Leary, K Rajender Reddy, Heather Patton, Patrick S Kamath, Michael B Fallon, Guadalupe Garcia-Tsao, Ram M Subramanian, Raza Malik, Benedict Maliakkal, Leroy R Thacker, Jasmohan S Bajaj, North American Consortium for Study of End-Stage Liver Disease
• Journal: Gastroenterology (Gastroenterology) Vol. 145 Issue 6 Pg. 1280-8.e1 (Dec 2013) ISSN: 1528-0012 [Electronic] United States
• PMID: 23999172 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Creatinine

Topics

• Acute Kidney Injury (blood, diagnosis, epidemiology)
• Aged
• Biomarkers (blood)
• Comorbidity
• Consensus
• Creatinine (blood)
• Female
• Follow-Up Studies
• Humans
• Length of Stay
• Liver Cirrhosis (epidemiology, mortality)
• Male
• Middle Aged
• Organ Dysfunction Scores
• Prospective Studies
• Survival Rate