Acute kidney injury in patients with cirrhosis: Prospective longitudinal study in 405 patients

Moga, Lucile; Robic, Marie‐Angèle; Blasco-Perrin, Hélène; Cabarrou, P; Mogno, Julie; Guillaume, Maéva; Vinel, Jean Pierre; Péron, Jean‐Marie; Bureau, Christophe

doi:10.1016/j.clinre.2021.101822

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…Similarly, patients with cirrhosis and AKI had lower 30-, 90-, and 180-day survival rates compared to patients without an AKI [27,28]. Survival rates were inversely proportional to the stage of AKI [28]. In a meta-analysis including 18,794 patients with cirrhosis, inpatient mortality was 6-fold higher in AKI patients compared to those without AKI.…”

Section: Discussionmentioning

confidence: 94%

“…One study showed a significant association between AKI and mortality with infections, hypovolemia due to gastrointestinal bleeding, and refractory ascites as major precipitating factors leading to renal dysfunction [26]. Similarly, patients with cirrhosis and AKI had lower 30-, 90-, and 180-day survival rates compared to patients without an AKI [27,28]. Survival rates were inversely proportional to the stage of AKI [28].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes, Mortality, and Cost Burden of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis

Patel

Zhang

Minacapelli

et al. 2023

JGLD

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Background and Aims: Cirrhosis is associated with an increased risk of acute kidney injury (AKI) and hepatorenal syndrome (HRS). Healthcare utilization and cost burden of AKI and HRS in cirrhosis is unknown. We aimed to analyze the health care use and cost burden associated with AKI and HRS in patients with cirrhosis in the United States by using real-world claims data. Methods: We conducted a case-control study using the Truven Health MarketScan Commercial Claims databases from 2007-2017. A total of 34,398 patients with cirrhosis with or without AKI and 4,364 patients with cirrhosis with or without HRS were identified using International Classification of Diseases, Ninth or Tenth Revision, codes and matched 1:1 by sociodemographic characteristics and comorbidities using propensity scores. Total and service-specific were quantified for the 12-months following versus the 12-months before the first date of AKI or HRS diagnosis and over 12-months following a randomly selected date for cirrhosis controls to capture entire disease burdens. Results: The AKI and HRS group had a higher number of comorbidities and were associated with higher rates of readmission and mortality. The AKI and HRS groups had a significantly higher prevalence of ascites, spontaneous bacterial peritonitis (SBP), encephalopathy, gastrointestinal bleeding, septic shock, pulmonary edema, and respiratory failure. Compared to patients with cirrhosis only, AKI was associated with higher number of claims per person (AKI vs. cirrhosis only, 60.30 vs. 47.09; p<0.0001) and total annual median health care costs (AKI vs. cirrhosis only, $46,150 vs. $26,340; p<0.0001). Compared to patients with cirrhosis only, the HRS cohort was associated with a higher number of claims per person (HRS vs. cirrhosis only, 44.96 vs. 43.50; p<0.0009) and total annual median health care costs (HRS vs. cirrhosis only, $34,912 vs. $23,354; p<0.0001). Inpatient costs were higher than the control cohort for AKI (AKI vs. cirrhosis only, $72,720 vs. $29,111; p<0.0001) and HRS (HRS vs. cirrhosis only, $ 98,246 vs. $27,503; p<0.0001). Compared to the control cohort, AKI and HRS had a higher rate of inpatient admission, mean number of inpatient admissions, and mean total length of stay. Conclusions: AKI and HRS are associated with higher health care utilization and cost burden compared to cirrhosis alone, highlighting the importance for improved screening and treatment modalities.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Outcomes, Mortality, and Cost Burden of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis

Patel

Zhang

Minacapelli

et al. 2023

JGLD

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“…Together, our data further strengthen the previous international evidence of AKI outcomes in cirrhosis, which would be of clinical value for the decision-making process and optimized management in practice. Starting treatment at the initial stages of AKI and early recovery may potentially result in improved survival [36]. Terlipressin is a vasopressin analogue that is suggested to have beneficial effects in improving survival among selected cirrhosis patients with kidney dysfunction [37,38].…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury development and impact on clinical and economic outcomes in patients with cirrhosis: an observational cohort study over a 10-year period

Alshogran

Altawalbeh

Al-Mestarihi

2023

European Journal of Gastroenterology &Amp; Hepatology

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Objectives Acute kidney injury (AKI) is a severe complication that is associated with significant morbidity and mortality in hospitalized cirrhotic patients. Data about AKI incidence and outcomes in patients with cirrhosis is scarce in the Middle East region. This study explored the incidence and impact of AKI on clinical and economic outcomes in cirrhosis. Methods This was a retrospective cohort study of cirrhosis patients admitted to an educational hospital in Jordan during the years 2012-2022. Demographics, clinical and biochemical information, and charges were retrieved from medical electronic records. Logistic regression models were conducted to evaluate predictors of AKI and mortality in cirrhosis adjusting for covariates. Hospital charges were also described. Results A total of 380 cirrhosis patients were included with an AKI incidence of 27.9%. Male sex, elevated baseline serum creatinine, presence of spontaneous bacterial peritonitis, and higher comorbidity score were independently associated with AKI development (P < 0.05). The hospital mortality rate was markedly higher for patients with AKI versus those without AKI (51.9% vs. 6.2%, respectively; P < 0.001). AKI was associated independently with higher odds of hospital death (OR = 5.83, P < 0.001), prolongation of the median hospital stays by 5 days (P < 0.001), more clinical complications, and increased total hospital charges per admission by $2500. Conclusion AKI is prevalent in cirrhosis patients, and it is associated with increased mortality, hospitalization, and cost. This burden in cirrhosis emphasizes the need for early identification of patients at high risk of AKI and applying prompt and effective management approaches, aiming at improving outcomes.

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“…In a prospective study of 405 patients with cirrhosis enrolled in 2016-2017, the prevalence of AKI was 19.3%, and survival was lower at 30 d and 90 d compared to that of non-AKI patients[ 99 ]. The prevalence of AKI ranges from 18.5% to 40.6% in some other regions[ 100 - 102 ].…”

Section: Epidemiology Of Major Complicationsmentioning

confidence: 99%

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

Liu¹,

Chen²

2022

World J Gastroenterol

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Cirrhosis causes a heavy global burden. In this review, we summarized up-to-date epidemiological features of cirrhosis and its complications. Recent epidemiological studies reported an increase in the prevalence of cirrhosis in 2017 compared to in 1990 in both men and women, with 5.2 million cases of cirrhosis and chronic liver disease occurring in 2017. Cirrhosis caused 1.48 million deaths in 2019, an increase of 8.1% compared to 2017. Disability-adjusted life-years due to cirrhosis ranked 16th among all diseases and 7th in people aged 50-74 years in 2019. The global burden of hepatitis B virus and hepatitis C virus-associated cirrhosis is decreasing, while the burden of cirrhosis due to alcohol and nonalcoholic fatty liver disease (NAFLD) is increasing rapidly. We described the current epidemiology of the major complications of cirrhosis, including ascites, variceal bleeding, hepatic encephalopathy, renal disorders, and infections. We also summarized the epidemiology of hepatocellular carcinoma in patients with cirrhosis. In the future, NAFLD-related cirrhosis will likely become more common due to the prevalence of metabolic diseases such as obesity and diabetes, and the prevalence of alcohol-induced cirrhosis is increasing. This altered epidemiology should be clinically noted, and relevant interventions should be undertaken.

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Acute kidney injury in patients with cirrhosis: Prospective longitudinal study in 405 patients

Cited by 7 publications

References 23 publications

Outcomes, Mortality, and Cost Burden of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis

Outcomes, Mortality, and Cost Burden of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis

Acute kidney injury development and impact on clinical and economic outcomes in patients with cirrhosis: an observational cohort study over a 10-year period

Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions

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