Impact of acute kidney injury on mortality in patients with acute variceal bleeding

Abstract

Background The effect of acute kidney injury (AKI) on patients with acute variceal bleeding (AVB) using the recently proposed International Club of Ascites (ICA) criteria is unclear. This study aimed to evaluate the incidence of AKI using the ICA criteria and factors associated with the outcomes in cirrhotic patients with AVB. Methods This retrospective cohort study included data of cirrhotic patients with AVB from two centers in Korea. The association of the ICA criteria for AKI with 6-week mortality was analyzed through univariate and multivariate analyses using the Cox proportional hazard model. Results In total, there were 546 episodes of AVB in 390 patients, of which 425 and 121 episodes were due to esophageal and gastric variceal bleeding, respectively. Moreover, 153 patients fulfilled the ICA criteria for AKI, and 64, 30, 39, and 20 patients were diagnosed with stages 1a, 1b, 2, and 3, respectively. Conversely, 97 patients developed AKI within 42 days as per the conventional criteria. The 6-week mortality rate was significantly higher in patients with ICA-AKI than in patients without ICA-AKI; the occurrence of ICA-AKI was an independent factor for predicting the 6-week mortality. Conclusion The ICA criteria could help diagnose renal dysfunction earlier, and presence of AKI is a predictor of mortality in patients with cirrhosis and AVB.

Development and validation of a nomogram for predicting overall survival in cirrhotic patients with acute kidney injury

“…Moreover, a number of studies have focused on identifying the risk factors for the development of AKI in patients with cirrhosis[ 16 - 19 ] and other conditions[ 20 - 22 ]. Furthermore, numerous studies have also evaluated the effect of AKI on the mortality of patients with cirrhosis[ 16 , 23 - 25 ]. A systematic review reported that the risk of death from AKI was increased more than 6-fold in patients with cirrhosis[ 24 ].…”

Acute Kidney Injury after Endoscopic Retrograde Cholangiopancreatography—A Hospital-Based Prospective Observational Study

“…The incidence of AKI related to digestive endoscopic procedures, such as oesophagogastroduodenoscopy, varied from 6.37% to 48.7%, depending on many different factors such as AKI definitions, patient population, or indications for oesophagogastroduodenoscopy [ 5 , 6 , 7 ]. In the case of colonoscopy, AKI occurred soon after endoscopy, and the reported incidence of AKI ranged from 1.16% to 41.2% [ 5 , 23 ].…”

“…The incidence of AKI related to digestive endoscopic procedures, such as oesophagogastroduodenoscopy, varied from 6.37% to 48.7%, depending on many different factors such as AKI definitions, patient population, or indications for oesophagogastroduodenoscopy [ 5 , 6 , 7 ]. In the case of colonoscopy, AKI occurred soon after endoscopy, and the reported incidence of AKI ranged from 1.16% to 41.2% [ 5 , 23 ]. In contrast, the literature with regard to the incidence of AKI after ERCP exists in scarce amounts, despite the fact that nowadays ERCP is a common procedure used for treating diseases of the biliary and pancreatic ducts, and its utilization has increased 30-fold in the last decades [ 3 ].…”

“…Acute kidney injury (AKI) is a severe clinical syndrome reported in patients undergoing endoscopic procedures such as colonoscopy [ 4 ] or endoscopy of the upper gastrointestinal tract for variceal [ 5 ] and nonvariceal bleeding [ 6 , 7 ]. Moreover, AKI occurs early after endoscopy and is associated with longer hospital stays, increased costs, and both short- and long-term mortality [ 5 , 6 , 7 ].…”