Validation of a Staging System for Acute Kidney Injury in Patients With Cirrhosis and Association With Acute-on-Chronic Liver Failure

Huelín, Patrícia; Piano, Salvatore; Solà, Elsa; Stanco, M.; Solé, Cristina; Moreira, Rebeca; Pose, Elisa; Fasolato, S.; Fabrellas, Núria; Prada, Glòria de; Pilutti, Chiara; Graupera, Isabel; Ariza, Xavier; Romano, A.; Elia, Chiara; Cárdenas, Andrés; Fernández, Javier; Angeli, Paolo; Ginès, Pere

doi:10.1016/j.cgh.2016.09.156

Cited by 148 publications

(191 citation statements)

References 20 publications

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“…Patients with AKI stage 1 were subgrouped into stage 1A (SCr < 1.5 mg/dL) and stage 1B (SCr ≥ 1.5 mg/dL) using a cut‐off value of SCr level of 1.5 mg/dL. The best cut‐off point of 1.5 mg/dL admission SCr for determining 3‐month prognosis in patients with AKI stage 1 was adopted from a previous study by Huelin et al …”

Section: Methodsmentioning

confidence: 99%

“…As a result of the multifactorial insults described above, patients with cirrhosis have a high prevalence of renal dysfunction . About 50% of patients admitted to the hospital for acute decompensation of cirrhosis have AKI during hospitalization, and one‐third develops AKI after admission during the course of treatment . Furthermore, even stable outpatients with cirrhosis may frequently develop AKI during follow‐up .…”

Section: Introductionmentioning

confidence: 99%

“…AKI has been classified into three stages (1–3) depending on the intensity of changes in SCr; this staging classification correlates well with prognosis in patients with cirrhosis,with stages 2 and 3 having a worse prognosis compared to stage 1 . However, recently, stage 1 has been further subdivided into two subgroups on the basis of serum levels of creatinine (SCr): stage 1A (SCr < 1.5 mg/dL) and stage 1B (SCr ≥ 1.5 mg/dL), and this subclassification is supported by differential outcomes . However, there is a lack of external validation of this subclassification of stage 1 AKI into 1A and 1B.…”

Section: Introductionmentioning

confidence: 99%

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Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease

et al. 2019

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Background and Aim Acute kidney injury (AKI) commonly occurs in patients with chronic liver disease (CLD). As per the International Club of Ascites, AKI is classified into three stages; stage 1 has recently been divided into subgroups 1A and 1B. We performed a prospective study to validate the association between subgrouping and outcome. Methods This study was conducted using decompensated cirrhosis (DC) patients hospitalized in the Gastroenterology ward between August 2016 and May 2018. Demographic, clinical, and laboratory parameters were compared between AKI 1A and AKI 1B patients. The duration of hospitalization and outcome were compared. Results A total of 528 subjects were enrolled; 296 (56.1%) had AKI, and of them, 61.48% ( n = 182) had stage 1, 20.95% ( n = 62) had stage 2, and 17.57% ( n = 52) had stage 3 AKI. Of the enrolled patients, 100 (54.94%) had early (AKI 1A) and 82 (45.06%) had late stage 1 AKI (AKI 1B). Patients with AKI 1B had higher total leucocyte count, total bilirubin, serum urea, serum creatinine (SCr), model for end‐stage liver disease (MELD), MELD‐Na + , and child‐turcotte‐pugh (CTP) score and decreased serum albumin than AKI 1A. The prevalence of hepatorenal syndrome (HRS), acute on chronic liver failure (ACLF) were higher in AKI 1B patients, and they had a prolonged hospital stay compared to AKI 1A patients. Furthermore, AKI 1B patients had significantly lower survival both at 28 days and 90 days. Conclusion Our study validates the subclassification of stage 1 AKI. Patients with AKI 1B more often progress to higher AKI stages with significantly lower 28‐day and 90‐day survival rates. Results justify subclassification and suggest the need for early intervention. The small increase in SCr should be viewed with caution in AKI stage 1A.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease

et al. 2019

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“…In this setting, comparing follow-up serum creatinine and baseline serum creatinine values is possible. There are patients who develop AKI before admission to the hospital, presenting with a high serum creatinine value [2]. In this case, the latest serum creatinine value should be used as the baseline value.…”

Section: Novel Classificationmentioning

confidence: 99%

“…Renal dysfunction is detected in 20-50% of patients who are admitted to the hospital [2]. It is one of the most serious complications of decompensated cirrhosis and leads to a rapid progress towards death or to liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Renal Failure in Patients with Liver Cirrhosis: Novel Classifications, Biomarkers, Treatment

Appenrodt

Lammert²

2018

Visc Med

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Renal failure is a severe complication in patients with liver cirrhosis. It is associated with increased mortality and morbidity. Diagnosis is a challenge because it is mainly based on serum creatinine, which does not seem to be an ideal measure of renal function in cirrhosis. The definition of renal failure in these patients has been changed for optimizing treatment and for improving outcome and prognosis. The new criteria are based on the adapted KDIGO (Kidney Disease: Improving Global Outcomes) staging system. The diagnosis of acute kidney injury (AKI) is based on an absolute increase of serum creatinine of >0.3 mg/dl from baseline within 48 h or an increase of >50% from baseline. This means smaller changes in serum creatinine in a shorter time frame which may lead to an early identification of renal failure in cirrhotic patients. The former cirrhotic-specific term hepatorenal syndrome (HRS) is now part of the new diagnostic criteria and is called HRS-AKI. The diagnostic criteria of HRS have changed due to the new criteria for AKI. Due to these criteria for HRS, the medical treatment will be started earlier. First-line treatment for renal AKI-HRS is the combination of a vasoconstrictor and albumin. Most data exist for terlipressin, a vasopressin analog, as vasoconstrictor. Besides this medical treatment, there are other options like the placement of a transjugular intrahepatic portosystemic shunt, renal replacement, and artificial extracorporeal liver support systems. However, these alternative treatment options have limitations. Liver transplantation is the treatment of choice for these patients and represents the definitive treatment. Using new biomarkers like urinary neutrophil gelatinase-associated lipocalin or interleukin-18 for renal failure in cirrhosis should help to differentiate the causes of renal failure and provide an indication regarding the prognosis.

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Hepatorenal Syndrome

Juanola

Cárdenas

Ginès

2022

Evidence‐Based Nephrology

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Validation of a Staging System for Acute Kidney Injury in Patients With Cirrhosis and Association With Acute-on-Chronic Liver Failure

Cited by 148 publications

References 20 publications

Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease

Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease

Renal Failure in Patients with Liver Cirrhosis: Novel Classifications, Biomarkers, Treatment

Hepatorenal Syndrome

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