Acute Kidney Injury at Admission Is a Better Predictor of Mortality than Its Persistence at 48 h in Patients with Acute-on-chronic Liver Failure

Abstract

Background and Aims: Acute kidney injury (AKI) occurs commonly in patients with acute-on-chronic liver failure (ACLF). However, there are scant data regarding the impact of AKI on survival in ACLF. We performed a prospective study to evaluate the impact of AKI on survival in ACLF.Methods: This study was conducted in ACLF patients hospitalized in the Gastroenterology Department of Sriram Chandra Bhanja Medical College (India) between October 2016 and February 2018. Demographic, clinical and laboratory parameters were recorded, and outcomes were compared between patients with and without AKI and between patients with persistent AKI and AKI reversal at 48 h.Results: We screened 439 chronic liver disease patients as per the Asian Pacific Association for the Study of the Liver criteria and found that 113 (25.7%) of them had ACLF and 78 (69%) of them had AKI as per the Acute Kidney Injury Network criteria. ACLF patients with AKI had reduced 28-day survival (44.9% vs. 74.3%; p = 0.004) and 90-day survival (25.6% vs. 51.4%; p = 0.007), in comparison to ACLF patients without AKI. However, when comparison was made between AKI reverters and AKI persisters at 48 h, survival was comparable for both at 28 days and 90 days. Further, about one-tenth of ACLF patients with AKI died within 48 h of hospitalization.Conclusions: Over two-thirds of ACLF patients had AKI. Although ACLF itself is a predictor of reduced survival, a very small increase in serum creatinine further worsens survival. Importantly, AKI at admission is a better predictor of early mortality in ACLF patients since recovery from AKI at 48 h does not improve survival.

Individual mortality risk predictive system of patients with acute-on-chronic liver failure based on a random survival forest model

“…The current study developed a novel online individual mortality risk predictive tool based on an RSF algorithm [35,36] age, [35,37,38] INR, [4,36,38,39] RDW, [40,41] AKI, [42][43][44] and serum sodium level. [45,46] The RSF algorithm could identify the variables that had a nonlinear effect on prognosis.…”

Safety and efficacy of terlipressin in acute-on-chronic liver failure with hepatorenal syndrome-acute kidney injury (HRS-AKI): a prospective cohort study

“…Organ failures, especially AKI, form the diagnostic criteria for ACLF according to the European Association for the Study of the Liver (EASL) definition 1 . Furthermore, the presence of AKI determines the outcome of patients with ACLF 2 – 4 . The cause of AKI in ACLF is multi-factorial 3 , 5 .…”

Hepatorenal syndrome in acute-on-chronic liver failure with acute kidney injury: more questions requiring discussion

“…[ 31 ] found that the proportion of patients with HRS-AKI was 3/20 in children and 22/380 in ACLF according to the EASL/CLIF criteria. However, some studies in the Asia-Pacific region have reported the epidemiologic data of HRS-AKI according to the APASL or CMA criteria ( Table 5 ) [ 14 , 24 , 32–38 ].…”