Abstract | Background: Methods: A prospective analysis was performed in 200 patients with decompensated cirrhosis with AKI to derive receiver operating curve, optimal cut-off, sensitivity, and specificity. These findings were validated in an independent cohort (n = 50) to differentiate ATN-AKI, HRS-AKI, and prerenal AKI. Results: The incidence of prerenal AKI, HRS-AKI, and ATN-AKI were 37.5%, 34%, and 28.5% in the derivation cohort and 28%, 38%, and 34% in the validation cohort respectively. The median FENa was significantly different in various phenotypes of AKI in the derivation and validation cohort (P 0.001); FEUrea was significantly different in the derivation cohort (P 0.0001), not in the validation cohort (P 0.106). The AUC for FENa (cut-off, sensitivity/specificity) was 86.6% (0.567, 89/71) and for FEUrea was 60.3% (34.73, 70/58) for ATN-AKI vs. non-ATN-AKI. The area under the curve for FENa to differentiate between HRS-AKI vs. non-HRS-AKI was 74.5%. FEUrea could not differentiate HRS-AKI vs. non-HRS-AKI (AUC 60.4%) satisfactorily. FENa and FEUrea were unable to differentiate between prerenal AKI and HRS-AKI (AUC <70%). Conclusion: Among cirrhotics FENa at admission is a simple, commonly available clinical tool that can be used to differentiate structural AKI from prerenal AKI and HRS-AKI. The newly derived lowered cut-off value of FENa makes the diagnosis of ATN-AKI easier, faster and thus obviates the need for extensive workup in a significant proportion of patients. FENa appears better than FEUrea in decompensated cirrhosis with AKI.
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Authors | Yashavanth H S Gowda, Nitin Jagtap, Arun Karyampudi, Nagaraja P Rao, Gujjarapudi Deepika, Mithun Sharma, Rajesh Gupta, Manu Tandan, Mohan Ramchandani, Priyadarshini John, Anand Kulkarni, Pramod Kumar, Bhushan Bhaware, Mohan V Turpati, D Nageshwar Reddy |
Journal | Journal of clinical and experimental hepatology
(J Clin Exp Hepatol)
2022 May-Jun
Vol. 12
Issue 3
Pg. 899-907
ISSN: 0973-6883 [Print] India |
PMID | 35677524
(Publication Type: Journal Article)
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Copyright | © 2021 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved. |