New Consensus Definition of Acute Kidney Injury Accurately Predicts 30-Day Mortality in Patients With Cirrhosis and Infection

• Type of Material: Article
• Authors: Florence Wong, University of Toronto; Jacqueline G O'Leary, Baylor University; K Rajender Reddy, University of Pennsylvania; Heather Patton, University of California San Diego; Patrick S Kamath, Mayo Clinic; Michael B Fallon, University of Texas; Guadalupe Garcia-Tsao, Yale University; Ram Subramanian, Emory University; Raza Malik, Beth Israel Deaconess Medical Centre; Benedict Maliakkal, University of Rochester; Leroy R Thacker, Virginia Commonwealth University; Jasmohan S Bajaj, Virginia Commonwealth University
• Language: English
• Date: 2013-12-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 by the AGA Institute.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1053/j.gastro.2013.08.051
• Title of Journal or Parent Work: Gastroenterologe
• ISSN: 1861-9681
• Volume: 145
• Issue: 6
• Start Page: 1280
• End Page: +
• Grant/Funding Information: Partly supported by NIH grant NIDDK RO1DK087913 and UL1RR031990 from the National Center for Research Resources.
• Keywords: RENAL-FAILURE; Liver Fibrosis; IMPAIRMENT; ALBUMIN; Science & Technology; SPONTANEOUS BACTERIAL PERITONITIS; SEPSIS; Hepatorenal Syndrome; Gastroenterology & Hepatology; Bacterial Infection; Life Sciences & Biomedicine; HEPATORENAL-SYNDROME; RIFLE CLASSIFICATION; PROGNOSIS; ASCITES; MELD
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

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.