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Am J Gastroenterol. 2017 Jul;112(7):1103-1110. doi: 10.1038/ajg.2017.122. Epub 2017 Apr 25.

Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes.

Author information

1
University of Toronto, Toronto, Ontario, Canada.
2
Baylor University Medical Center, Dallas, Texas, USA.
3
University of Pennsylvania, Philadelphia, Pennsylvania, USA.
4
Yale University, New Haven, Connecticut, USA.
5
Health Science Center, University of Texas, Houston, Texas, USA.
6
University of Colorado Denver, Denver, Colorado, USA.
7
Emory University, Atlanta, Georgia, USA.
8
Mercy Medical Center &University of Maryland School of Medicine, Baltimore, Maryland, USA.
9
Mayo Clinic, Rochester, Minnesota, USA.
10
University of California San Diego, San Diego, California, USA.
11
University of Rochester, Rochester, New York, USA.
12
University of Alberta, Edmonton, Alberta, Canada.
13
Mayo Clinic, Scottsdale, Arizona, USA.
14
Biostatisitcs, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.
15
Medicine, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.

Abstract

OBJECTIVES:

The International Ascites Club (IAC) recently defined Stage 1 acute kidney injury (AKI) for cirrhosis as an acute increase in serum creatinine (SCr) by ≥0.3 mg/dl or by ≥50% in <48 h from a stable value within 3 months. The baseline SCr may influence AKI risk and patient outcomes. The objective of this study is to determine in cirrhosis whether the baseline SCr has any effect on the in-hospital AKI course and patient survival.

METHODS:

North American Consortium for the Study of End-Stage Liver Disease is a consortium of tertiary-care hepatology centers prospectively enroling non-elective cirrhotic inpatients. Patients with different baseline SCr levels (≤0.5, 0.51-1.0, 1.01-1.5, >1.5 mg/dl) were evaluated for the development of AKI, and compared for AKI outcomes and 30-day survival.

RESULTS:

653 hospitalized cirrhotics (56.7±10years, 64% men, 30% with infection) were included. The incidence of AKI was 47% of enrolled patients. Patients with higher baseline SCr were more likely to develop AKI, with significantly higher delta and peak SCr (P<0.001) than the other groups, more likely to have a progressive AKI course (P<0.0001), associated with a significantly reduced 30-day survival (P<0.0001). Multivariate logistic regression showed that the delta SCr during an AKI episode to be the strongest factor impacting AKI outcomes and survival (P<0.001), with a delta SCr of 0.70 mg/dl having a 68% sensitivity and 80% specificity for predicting 30-day mortality.

CONCLUSIONS:

Admitted cirrhotic patients with higher baseline SCr are at higher risk for in-hospital development of AKI, and more likely to have AKI progression with reduced survival. Therefore, such patients should be closely monitored and treated promptly for their AKI.

PMID:
28440305
DOI:
10.1038/ajg.2017.122
[Indexed for MEDLINE]

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