Impact of acute kidney injury on prognosis of patients with liver cirrhosis and ascites: A retrospective cohort study

Bucsics, Theresa; Mandorfer, Mattias; Schwabl, Philipp; Bota, Simona; Ferlitsch, Arnulf; Trauner, Michael; Peck‐Radosavljevic, Markus; Reiberger, Thomas

doi:10.1111/jgh.13002

Cited by 38 publications

(38 citation statements)

References 42 publications

(95 reference statements)

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“…18 Despite previous SCr thresholds being considered for clinical relevance in cirrhotic patients, 24 lesser degrees of baseline renal dysfunction can be associated with reduced survival. 18,23,25 In fact, in our cohort, the baseline SCr threshold with highest validity for predicting AKI was 0.9 mg/dL. The MELD score is a validated prognostic marker in a wide range of severity and causes of cirrhosis, which incorporates an assessment of renal function.…”

Section: Discussionmentioning

confidence: 68%

“…[19][20][21] The KDIGO classification accurately detects minor variations in SCr values which have been associated with poor prognosis in cirrhotic patients. 18,22,23 In addition, AKI superimposed on previous renal dysfunction confers a higher risk for mortality. 18 Despite previous SCr thresholds being considered for clinical relevance in cirrhotic patients, 24 lesser degrees of baseline renal dysfunction can be associated with reduced survival.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

Gameiro¹,

Fonseca²,

Dias³

et al. 2018

IJNRD

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IntroductionAcute kidney injury (AKI) is common in hospitalized patients with cirrhosis and is associated with poor prognosis. A risk prediction score combining values easily measured at admission could be valuable to stratify patients for prevention, monitoring and early intervention, ultimately improving patient care and outcomes. The aim of this study was to develop a risk score for AKI in a cohort of cirrhotic patients.Patients and methodsWe cross-examined the data from a retrospective analysis of 186 patients with cirrhosis admitted to the Gastroenterology and Hepatology Service of Centro Hospitalar Lisboa Norte from January 2003 to December 2005. AKI was defined as an increase in serum creatinine (SCr)≥0.3 mg/dL within 48 hours or a percentage increase in SCr≥50% from baseline. Neutrophil-to-lymphocyte ratio (NLR) was used as a marker for inflammation. A receiver operating characteristic (ROC) curve was produced to assess the discriminative ability of the variables. Cutoff values were defined as those with highest validity. The final AKI risk score model was assessed using the ROC curve.ResultsA total of 52 patients (28%) developed AKI. Higher baseline SCr (p<0.001), more severe liver disease as evaluated by the modified Model of End-stage Liver Disease (MELD)-Na score (p<0.001) and higher NLR (p=0.028) were independently associated with AKI. The area under the ROC (AUROC) curve for the prediction of AKI was 0.791 (95% CI 0.726–0.847) for SCr, 0.771 (95% CI 0.704–0.829) for modified MELD-Na and 0.757 (95% CI 0.689–0.817) for NLR. Cutoff values with the highest validity for predicting AKI were determined and defined as 0.9 for the SCr, 21.7 for the modified MELD-Na and 6 for the NLR. The risk score was created allowing 3 points if the SCr is higher than 0.9, 1 point if the modified MELD-Na is higher than 21.7 and 1 point if the NLR is higher than 6. The AUROC curve of the risk prediction score for AKI was 0.861. A risk score of ≥2 points predicts AKI in cirrhotic patients with a sensitivity of 88.5% and specificity of 72.4%.ConclusionA new score combining SCr, MELD-Na and NLR demonstrated a strong discriminative ability to predict AKI in cirrhotic patients.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

Gameiro¹,

Fonseca²,

Dias³

et al. 2018

IJNRD

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“…Acute kidney injury is an important risk factor associated with the prognosis of cirrhotic patients. Especially, AKI is a significant predictor for mortality in cirrhotic patients with ascites . Therefore, early detection and adequate management of AKI can lead to improved prognosis of cirrhotic patients with ascites.…”

Section: Discussionmentioning

confidence: 99%

Effect of acute kidney injury on long‐term outcomes of spontaneous bacterial peritonitis in cirrhotic patients using the International Club of Ascites‐acute kidney injury criteria

Sohn

Kim

Cho

2019

J of Gastro and Hepatol

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Background and Aim: This study aimed to investigate the effect of acute kidney injury (AKI) on long-term mortality of spontaneous bacterial peritonitis (SBP) in cirrhotic patients using International Club of Ascites (ICA)-AKI criteria. Methods: A total of 157 cirrhotic patients with a first episode of SBP between 2007 and 2016 were analyzed. We investigated the long-term mortality with related risk factors of SBP in cirrhosis including the ICA-AKI criteria. The ICA-AKI stage at SBP diagnosis is evaluated by stages 0-3. Stage progression was defined as a progression of AKI to a higher stage.Results: The ICA-AKI stage at the diagnosis of SBP was stage 0 in 91 (58%), stage 1 in 33 (21%), stage 2 in 19 (12%), and stage 3 in 14 patients (9%). Stage progression within 48 h after SBP diagnosis was noted in 18 patients (12%). Multivariable analysis showed that the risk factors for overall survival were age ≥ 60 years (hazard ratio [HR] 1.74, P = 0.029), serum sodium ≤ 130 mmol/L (HR 1.3, P = 0.017), ICA-AKI stage 1 (HR 2.51, P = 0.003), ICA-AKI stage 2 or 3 (HR 3.36, P < 0.001), and stage progression at 48 h after SBP diagnosis (HR 2.57, P = 0.004). The differences in overall survival using the ICA-AKI in patients without AKI using the conventional criteria were significantly different (P = 0.019). Conclusion: Acute kidney injury and its progression are significant risk factors for mortality in cirrhotic patients with SBP. The application of the ICA-AKI criteria is important and advantageous for early evaluation and intervention for a better prognosis in cirrhotic patients with SBP.

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“…Furthermore, Fagundes et al developed a ‘new classification’ that combined the AKIN criteria and traditional criterion in cirrhosis [9] (i) stage 1 with a final sCr of ≤1.5 mg/dl; (ii) stage 1 with a final sCr of >1.5 mg/dl, and (iii) combined stages 2 and 3, providing a better prognostic stratification than AKIN criteria alone. Whereas, it has recently been challenged that even “mild” AKI in cirrhotic patients whose peak sCr remained below 1.5mg/dl had a surprisingly higher mortality rate compared to those without AKI, indicating that the ‘new classification’ proposed by Fagundes et al did not improve the prognostic assessment of patients with cirrhosis [18, 19]. Therefore, it seems all of these various criteria are not that perfect, still requiring further refinement.…”

Section: Discussionmentioning

confidence: 99%

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

Zhou¹,

Luo²,

Lv³

et al. 2017

Kidney Blood Press Res

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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.

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Impact of acute kidney injury on prognosis of patients with liver cirrhosis and ascites: A retrospective cohort study

Abstract: AKIN criteria-considering small increases in serum creatinine rather than absolute thresholds-seem to be more accurate for estimating prognosis of AKI after paracentesis than C-AKI criteria. Even patients developing AKI-1 with "normal" serum creatinine are at increased risk for mortality.

Cited by 38 publications

References 42 publications

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

Effect of acute kidney injury on long‐term outcomes of spontaneous bacterial peritonitis in cirrhotic patients using the International Club of Ascites‐acute kidney injury criteria

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

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