Evaluation of Absolute Serum Creatinine Changes in Staging of Cirrhosis-Induced Acute Renal Injury and its Association with Long-term Outcomes

Abstract

Background/Aims: To assess the prognostic accuracy of absolute serum creatinine (sCr) changes (‘Delta-sCr’) on the long-term outcomes in cirrhotic patients, and evaluate the performance of the ‘Delta-sCr’ approach to stage acute kidney injury (AKI), compared with the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Methods: We conducted a retrospective analysis of 333 hospitalized patients. We classified AKI stages using two methods: 1) KDIGO AKI criteria; 2) ‘Delta-sCr’ system, defined by the difference between the baseline and the peak sCr value during the hospitalization. The end point was the hazard of 1-year death. Results: The prevalence of AKI in cirrhotic patients was 18.01% by the KDIGO criteria, and 25.22% by the ‘Delta-sCr’ system. On multivariable Cox hazard analysis, both of the two methods were independent predictive factors of death (‘Delta-sCr’ system: OR=2.911, p<0.001), (KDIGO criteria: OR=2.065, p<0.001). However, the ‘Delta-sCr’ system provided a modest improvement in classification over the KDIGO criteria with a net reclassification improvement (NRI) of 28.7% (p<0.001) and integrated discrimination improvement (IDI) of 7.5% (p=0.03). And the predictive value of the ‘Delta-sCr’ system could be significantly improved (p=0.006), when combined with age and MELD score. Conclusion: The Delta-sCr is associated with the 1-year mortality. And the ‘Delta-sCr’ system may optimize the discrimination of risk prediction.

Incidence, Mortality and Predictors of Acute Kidney Injury in Patients with Cirrhosis: A Systematic Review and Meta-analysis

“…48 With each episode of AKI, the renal reserve declines due to the inability of kidneys to recover function completely to original baseline level and resulting in risk for development of chronic kidney disease and impacting the outcomes negatively. 31,33 While patients with cirrhosis constitute a heterogeneous cohort, the subpopulations at an increased risk of developing AKI have not been sufficiently studied. In our pooled analysis, model for end-stage liver disease score, Child-Pugh stage, presence of ascites, and presence of severe sepsis/septic shock were associated with an elevated risk of developing an AKI.…”

“… 48 With each episode of AKI, the renal reserve declines due to the inability of kidneys to recover function completely to original baseline level and resulting in risk for development of chronic kidney disease and impacting the outcomes negatively. 31 , 33 …”

Reduction in acute kidney injury stage predicts survival in patients with type-1 hepatorenal syndrome

“…Patients with AKI who had the greatest change SCr were more likely to have a progressive AKI course, which was associated with significantly reduced 30-day survival [ 27 ]. In fact, a large change in SCr during an AKI episode has been the strongest factor impacting AKI outcomes and survival [ 27 , 28 ]. The corollary from this observation is that HRS-1 treatment should begin as soon as the diagnostic criteria are met, which means as soon as there is doubling of SCr without regard for a particular SCr threshold to be reached [ 3 ].…”