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

Abstract

Background and Aims: Acute kidney injury (AKI) is common in patients with cirrhosis but the incidence is heterogeneous among studies. We performed a meta-analysis to describe the incidence of AKI and its impact on patient mortality in patients with cirrhosis. We also evaluated the admission variables predicting development of AKI. Methods: A systematic search of various databases was performed up to November 2018. Meta-analyses were performed using random effects models. Results: Of 18,474 patients with cirrhosis from 30 selected studies, 5,648 developed AKI, with a pooled incidence of 29% (95% confidence interval [CI]: 28-30%, I 2 of 99%). In-hospital mortality assessed in eight studies was six-fold higher among AKI patients, as compared to those without AKI (odds ratio [OR] 6.72, 95% CI: 3.47-13, p<0.0001, I 2 of 70%). Three studies on patients admitted to intensive care showed about six-fold higher mortality among AKI patients (OR 5.90, 95% CI: 3.21-10.85, p>0.0001). Mortality remained significantly high, at days 30 and 90 and even at 1-year follow up after development of AKI. Of 12 admission variables analyzed, model for end-stage liver disease score, Child-Pugh-Turcotte stage C, presence of ascites, and presence of sepsis/septic shock were statistically significant risk factors for AKI. Conclusions: AKI occurred in about 29% of patients with cirrhosis and is associated with a six-fold increased risk of in-hospital mortality. Mortality remained high even in long-term follow-up of 1 year. Patients at risk for AKI development can be recognized at admission. Prospective studies are needed to develop strategies for improving outcome of these patients.

Acute Kidney Injury in Patients with Liver Cirrhosis: Prevalence, Predictors, and In-Hospital Mortality at a District Hospital in Ghana

“…However, high BUN, high MELDNa, high INR, and ALP were clinical parameters and scores that were independent predictors of AKI. Tariq et al [38] reported MELD, CPS stage C, presence of ascites, and presence of sepsis/septic shock as predictors associated with AKI. Gameiro et al [39] in their study also identified MELDNa and neutrophil-to-lymphocyte ratio as an independent predictive factor of AKI.…”

Impact of liver cirrhosis on ST-elevation myocardial infarction related shock and interventional management, a nationwide analysis

“…A recent meta-analysis finds that AKI increases the risk of acute coronary syndrome, suggesting that AKI increases the risk of early mortality[ 19 ]. Our study suggests AKI, one of the most common complications of cirrhosis, is one of the highest predictors of mortality in the LC cohort, second only to cardiac arrest[ 1 , 20 ]. This is likely due to the underlying disease-specific physiology of cirrhosis.…”

Association Between Different Versions of the Model for End-Stage Liver Disease Score and Contrast-Associated Acute Kidney Injury in Patients Undergoing Elective Percutaneous Coronary Intervention

“…6 Tariq et al performed a meta-analysis involving 18,474 patients with cirrhosis and found that the MELD score was related to AKI. 7 In addition, an increased MELD-XI score was validated to be an independent risk factor for AKI in patients with postcardiotomy cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation by another retrospective study. 8 Similarly, in a prospective observational study, 131 patients who underwent hepatobiliary surgeries were analyzed and it was suggested that a higher level of the MELD-Na score was significantly associated with an increased risk of developing AKI.…”