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Gastroenterology. 2013 Dec;145(6):1280-8.e1. doi: 10.1053/j.gastro.2013.08.051. Epub 2013 Aug 30.

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

Author information

1
Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada. Electronic address: florence.wong@utoronto.ca.

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.

KEYWORDS:

ADQI; AKI; Acute Dialysis Quality Initiative; Bacterial Infection; HRS; Hepatorenal Syndrome; LOS; Liver Fibrosis; MAP; MELD; Model for End-Stage Liver Disease; SBP; UTI; acute kidney injury; hepatorenal syndrome; length of stay; mean arterial pressure; spontaneous bacterial peritonitis; urinary tract infection

PMID:
23999172
PMCID:
PMC4418483
DOI:
10.1053/j.gastro.2013.08.051
[Indexed for MEDLINE]
Free PMC Article

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