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J Hepatol. 2013 Sep;59(3):482-9. doi: 10.1016/j.jhep.2013.03.039. Epub 2013 May 7.

Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites.

Author information

1
Department of Medicine (DIMED), University of Padova, Padova, Italy.

Abstract

BACKGROUND & AIMS:

For several years hepatologists have defined acute renal failure in patients with cirrhosis as an increase in serum creatinine (sCr) ≥ 50% to a final value of sCr>1.5mg/dl (conventional criterion). Recently, the Acute Kidney Injury Network (AKIN) defined acute renal failure as acute kidney injury (AKI) on the basis of an absolute increase in sCr of 0.3mg/dl or a percentage increase in sCr ≥ 50% providing also a staging from 1 to 3. AKIN stage 1 was defined as an increase in sCr ≥ 0.3mg/dl or increase in sCr ≥ 1.5-fold to 2-fold from baseline. AKI diagnosed with the two different criteria was evaluated for the prediction of in-hospital mortality.

METHODS:

Consecutive hospitalized patients with cirrhosis and ascites were included in the study and evaluated for the development of AKI.

RESULTS:

Conventional criterion was found to be more accurate than AKIN criteria in improving the prediction of in-hospital mortality in a model including age and Child-Turcotte-Pugh score. The addition of either progression of AKIN stage or a threshold value for sCr of 1.5mg/dl further improves the value of AKIN criteria in this model. More in detail, patients with AKIN stage 1 and sCr<1.5mg/dl had a lower mortality rate (p=0.03), a lower progression rate (p=0.01), and a higher improvement rate (p=0.025) than patients with AKIN stage 1 and sCr ≥ 1.5mg/dl.

CONCLUSIONS:

Conventional criterion is more accurate than AKIN criteria in the prediction of in-hospital mortality in patients with cirrhosis and ascites. The addition of either the progression of AKIN stage or the cut-off of sCr ≥ 1.5mg/dl to the AKIN criteria improves their prognostic accuracy.

KEYWORDS:

ADQI; AKI; AKIN; Acute Dialysis Quality Initiative; Acute Kidney Injury; Acute Kidney Injury Network; Albumin; HRS; Hepatorenal syndrome; ICA; International Club of Ascites; NSAIDs; Renal failure; SBP; Serum creatinine; Terlipressin; hepatorenal syndrome; non-steroidal anti-inflammatory drugs; sCr; serum creatinine; spontaneous bacterial peritonitis

PMID:
23665185
DOI:
10.1016/j.jhep.2013.03.039
[Indexed for MEDLINE]

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