Sepsis-induced acute kidney injury in patients with cirrhosis

Abstract

Acute kidney injury (AKI) is a common and life-threatening complication in patients with cirrhosis. Recently, new criteria for the diagnosis of AKI have been proposed in patients with cirrhosis by the International Club of Ascites. Almost all types of bacterial infections can induce AKI in patients with cirrhosis representing its most common precipitating event. The bacterial infection-induced AKI usually meets the diagnostic criteria of hepatorenal syndrome (HRS). Well in keeping with the "splanchnic arterial vasodilation hypothesis", it has been stated that HRS develops as a consequence of a severe reduction of effective circulating volume related to splanchnic arterial vasodilation and to an inadequate cardiac output. Nevertheless, the role of bacterial infections in precipitating organ failures, including renal failure, is enhanced when their course is characterized by the development of a systemic inflammatory response syndrome (SIRS), thus, when sepsis occurs. Sepsis has been shown to be capable to induce "per se" AKI in animals as well as in patients conditioning also the features of renal damage. This observation suggests that when precipitated by sepsis, the pathogenesis and the clinical course of AKI also in patients with cirrhosis may differentiate to a certain extent from AKI with another or no precipitating factor. The purpose of this review is to describe the features of AKI precipitated by bacterial infections and to highlight whether infection and/or the development of SIRS may influence its clinical course, and, in particular, the response to treatment.

Terlipressin Is Superior to Noradrenaline in the Management of Acute Kidney Injury in Acute on Chronic Liver Failure

“…Assuming a response rate in terlipressin as 56% and in noradrenaline as 43%, and a 10% noninferiority margin, with an alpha error of 5% and power of 80%, we needed to enroll 57 cases in each arm. (21,22) Statistical analyses were performed using SPSS software (version 20.0; IBM Corp., Armonk, NY). Patient clinical and biochemical indices are expressed either as mean ± SD or median (interquartile range; IQR).…”

“…All authors had access to the study data and reviewed and approved the final manuscript. Assuming a response rate in terlipressin as 56% and in noradrenaline as 43%, and a 10% noninferiority margin, with an alpha error of 5% and power of 80%, we needed to enroll 57 cases in each arm …”

Presepsin teardown - pitfalls of biomarkers in the diagnosis and prognosis of bacterial infection in cirrhosis

“…Secondly, elimination of certain molecules can be affected by renal failure and also renal replacement therapy. Acute kidney injury (AKI) is frequent in patients with cirrhosis, especially in bacterial infections[11]. While CRP has a high molecular weight (MW) (115-kDa) and its renal clearance is negligible[12,13], PCT is small with a MW of 13 kDa, and renal elimination is thought to be one of the major pathways for its elimination[14].…”

Clinical characteristics and prognostic factors of liver cirrhosis patients with systemic inflammatory response syndrome

“…Much evidence from previous studies suggested that SIRS had a negative effect on the outcome of cirrhotic patients. It was indicated that SIRS correlated with portal hypertension‐related bleeding, acute renal function deterioration, HE, and even extra‐hepatic organ failure. The pathogenic explanation may be cytokine synthesis and release in patients with SIRS, which leads to derangement of systemic and renal hemodynamics that may end in hepatorenal syndrome .…”

“…21 The presence of SIRS at admission affected both the liver and kidney function, 22,23 and could predict the development of ARF and severe hepatitis. 17 Acute renal function failure is one of the most serious complications of SIRS and was strongly associated with organ failure. 10,24 In our study, Cr ≥175 μmol/L was shown to be an independent risk factor for 90-day mortality (HR = 2.768; CI, 1.53-5.04; P = 0.001).…”