Acute kidney injury in patients with cirrhosis of liver: Clinical profile and predictors of outcome

Shetty, Shiran; Nagaraju, Shankar Prasad; Shenoy, Srinivas Vinayak; Attur, Ravindra Prabhu; Rangaswamy, Dharshan; Rao, Indu Ramachandra; Mateti, Uday Venkat; Parthasarathy, R.

doi:10.1007/s12664-018-0867-4

Cited by 13 publications

(12 citation statements)

References 14 publications

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“…Surprisingly, the hospital mortality rate in our study was much lower—only 17.8%—in contrast to 52.7% reported by de Carvalho et al . and 44.7% by Shetty et al 18,31 . In addition, the 28‐day mortality rate in our AKI patients was 33.3%, which is similar to Wong et al .…”

Section: Discussionsupporting

confidence: 90%

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Acute kidney injury in hospitalized cirrhotic patients: Risk factors, type of kidney injury, and survival

et al. 2020

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Background and AimAcute kidney injury (AKI) is a common complication of chronic liver disease (CLD). We performed a prospective study to evaluate the risk factors and spectrum of AKI among decompensated cirrhosis (DC) patients and the impact of AKI on survival.MethodsThis study was conducted in consecutive DC patients hospitalized in SCB Medical College between December 2016 and October 2018. AKI was defined as per ICA criteria. Demographic, clinical, and laboratory parameters and outcomes were compared between patients with and without AKI.ResultsA total of 576 DC subjects were enrolled, 315 (54.69%) of whom had AKI; 34% (n = 106) had stage 1A, 28% (n = 90) stage 1B, 21% (n = 65) stage 2, and 17% (n = 54) stage 3 AKI. Alcohol was the predominant cause of CLD (66.7%). In 207 (65.7%) patients, diuretic/lactulose/nonsteroidal anti‐inflammatory drugs use was noted, and infection was present in 190 (60.3%) patients. Compared to those without AKI, patients with AKI had higher leucocyte count, higher serum urea and creatinine, higher Child‐Turcotte‐Pugh, higher Model of End‐Stage Liver Disease (MELD) scores (P < 0.001), longer hospital stay, and lower survival at 28 days and 90 days (P < 0.001). Besides, in patients with stages 1A to 3 AKI, there were differences in overall survival at 28 days (P < 0.001) and 90 days (P < 0.001).ConclusionsOver half of DC patients had AKI, and alcohol was the most common cause of cirrhosis in them. Use of AKI‐precipitating medications was the most common cause of AKI, followed by bacterial infection. AKI patients had increased prevalence of acute‐on‐chronic liver failure and had prolonged hospitalization and lower survival both at 28 days and 90 days.

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Section: Discussionsupporting

confidence: 90%

“…The prevalence of AKI in other studies varies between 46 and 67%, akin to our study (54.69%) (Table 5). 7,10,11,17,18,31,32 In our patients, alcohol was the most common underlying etiology of cirrhosis. In contrast, de Carvalho et al .…”

Section: Discussionmentioning

confidence: 67%

Acute kidney injury in hospitalized cirrhotic patients: Risk factors, type of kidney injury, and survival

et al. 2020

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“…In regards to AKI, small single centered studies have previously shown worsening of patient outcomes in intensive care unit patients [13] and elderly patients [14] admitted for all cause UGIB. The role and pathophysiology of AKI in VUGIB bleeding has also been previously defined [15,16]. However, there is no current large-or small-scale population-based study evaluating the independent role of AKI as a prognostic marker among hospitalized NVUGIB patients.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…another study of 113 elderly patients with upper gastrointestinal bleeding, patients with AKI had increased length of stay and hospitalization costs and presented more often with altered mental status and weakness [14]. Retrospective studies in cirrhotic patients with variceal bleeding have demonstrated similar results [15,16]. However, the segregation of variceal and non-variceal bleeding is important as the pathophysiology of acute renal dysfunction is distinct in patients with chronic liver disease.…”

Section: Significant Associations Of Akimentioning

confidence: 99%

“…However, the segregation of variceal and non-variceal bleeding is important as the pathophysiology of acute renal dysfunction is distinct in patients with chronic liver disease. Well-established mechanisms for renal injury in these patients include hyper-dynamic circulation, hepatorenal syndrome, intravascular volume depletion secondary to diuretic and lactulose use, as well as increased susceptibility to nephrotoxic agent exposure such as nonsteroidal anti-inflammatory drugs, contrast agents, and aminoglycosides [16,23]. Consequently, we isolated patients with AKI and non-variceal upper gastrointestinal bleeding in our cohort, as there are no large-scale studies analyzing this phenomenon.…”

Section: Significant Associations Of Akimentioning

confidence: 99%

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Impact of Acute Kidney Injury in Hospitalizations with Non-Variceal Upper Gastrointestinal Bleeding

Kabaria¹,

Tawadros²,

Laura³

et al. 2021

J Gastroenterol Res

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Background: Acute Kidney Injury (AKI) is a commonly occurring comorbidity in hospitalized patients. Our objective was to identify the role of AKI in relation to the morbidity and mortality in Non-Variceal Upper Gastrointestinal Bleeding (NVUGIB) patients.Study: Nationwide Inpatient Sample (NIS) database was used from the year 2000 to 2014 and queried for patients with NVUGIB. Patients were further stratified with and without the presence of concomitant AKI. Weighed multivariate regression analyses were performed to determine the final conclusions of the study.Results: Total of 4,889,410 patients with NVUGIB were identified during the study period. AKI was a comorbid condition in 6.37% of all patients. Incidence of AKI in NVUGIB patients has increased over five-fold over the study period. After adjusting for confounders through multivariate regression model, patients in the AKI group had higher odds of mortality (OR 2.84, p < 0.001). Additionally, patients with AKI were more likely to receive blood transfusion (OR 1.30, p < 0.001), had longer length of stay (+ 1.73 days, p < 0.001), had higher hospital charges (+ $16,221, p < 0.001), and had higher disposition to intermediate care facility (OR 1.84, p < 0.001).Conclusions: Incidence of AKI in hospitalized NVUGIB patients has increased dramatically. Interestingly, AKI is also associated with higher morbidity and mortality in NVUGIB patients. Consequently, AKI should be used as a marker for disease severity in hospitalized NVUGIB patients.

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Study of prevalence, risk factors for acute kidney injury, and mortality in liver cirrhosis patients

Mohan,

Nagaraju,

Musunuri

et al. 2024

Ir J Med Sci

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Introduction Acute kidney injury (AKI) occurs frequently in patients with end-stage liver disease and cirrhosis and is associated with increased short-term mortality. This study aims to study the prevalence and risk factors associated with AKI development and mortality in cirrhosis of liver patients. Methodology In the current prospective study, hospitalized patients with liver cirrhosis from October 2021 to March 2023 were recruited. Demographic, clinical, and laboratory data were collected, which included, the etiology of cirrhosis, comorbidities, severity of liver disease, and relevant biochemical parameters. The patient was followed up for 90 days to record the clinical outcome. The statistical software SPSS was utilized to conduct the analysis. Results Of 364 liver cirrhosis patients, 25.2% (n, 92) had AKI and belonged to an average age of 51.54 ± 11.82 years. The majority of individuals in the study were males (90.4%), and alcohol (63.4%) was the most common etiology of liver cirrhosis. The present study showed that higher level of direct bilirubin (p = 0.011) and MELD score (p = 0.0001) were identified as significant risk factors for AKI development in patients with liver cirrhosis. Regarding mortality, the significant risk factors were the presence of AKI (p = 0.045) and MELD score (p = 0.025). Among AKI patients, 90-day mortality rates were higher in patients with acute tubular necrosis (p value = 0.010) and stage 3 AKI (p value = 0.001). Conclusion AKI is common in cirrhosis of liver patients. Elevated levels of direct bilirubin and MELD score emerged as significant factors associated with AKI development. Furthermore, AKI and MELD scores were identified as independent risk factors for mortality at both 30 and 90 days. Survival rates were influenced by both the type and stage of AKI; AKI stage 3 and ATN patients had significantly higher mortality rate. Early AKI detection and management are crucial for reducing mortality risk in liver cirrhosis patients.

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Acute kidney injury in patients with cirrhosis of liver: Clinical profile and predictors of outcome

Abstract: Acute kidney injury in cirrhosis of liver carries high in-hospital mortality. Pre-renal AKI has a better survival compared to ATN and HRS. The higher stage of AKI at presentation and the presence of oliguria are two important predictors of in-hospital mortality.

Cited by 13 publications

References 14 publications

Acute kidney injury in hospitalized cirrhotic patients: Risk factors, type of kidney injury, and survival

Acute kidney injury in hospitalized cirrhotic patients: Risk factors, type of kidney injury, and survival

Impact of Acute Kidney Injury in Hospitalizations with Non-Variceal Upper Gastrointestinal Bleeding

Study of prevalence, risk factors for acute kidney injury, and mortality in liver cirrhosis patients

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