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

Abstract

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.

Terlipressin May Decrease In-Hospital Mortality of Cirrhotic Patients with Acute Gastrointestinal Bleeding and Renal Dysfunction: A Retrospective Multicenter Observational Study

“…Cirrhotic patients at AKI stage 1 with sCr \ 133 lmol/L had a similar survival rate to those without AKI according to the Acute Kidney Injury Network criteria, but higher resolution and lower mortality than those at AKI stage 1 with sCr [ 133 lmol/L [20,24]. Similarly, cirrhotic patients at AKI stage 1 with sCr C 133 lmol/L had significantly longer hospital stay and lower AKI resolution and survival rates as compared to those at AKI stage 1 with sCr \ 133 lmol/L according to the ICA-AKI criteria [31]. In addition, the significant detrimental effect of sCr [ 133 lmol/L on resolution and survival is also reported in cirrhotic patients with gastric variceal bleeding at any AKI stage [8].…”

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

“…Reversibility was higher with hypovolemia but greater number of deaths were seen in patients with HRS and sepsis. 109 …”

“…Thus other causes of AKI such as hypovolemia, shock, urinary tract obstruction, use of nephrotoxic medication and parenchymal diseases of kidney have been ruled out. 101 , 107 - 109 …”

“…Thus other causes of AKI such as hypovolemia, shock, urinary tract obstruction, use of nephrotoxic medication and parenchymal diseases of kidney have been ruled out. 101,[107][108][109] The box below gives the revised diagnostic criteria for HRS-AKI Baseline sCr A value of sCr obtained in the previous 3 months when available can be used as baseline sCr.…”

Acute kidney injury in hospitalized cirrhotic patients: Risk factors, type of kidney injury, and survival

“…Furthermore, AKI has been classified by the ICA‐AKI criteria into three stages (1–3) depending on the intensity of rise in SCr, and this staging classification correlates well with prognosis in patients with cirrhosis, 17,18 with stages 2 and 3 having worse prognosis compared with stage 1 4,8,9,10,17,19 . 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 justified by the differential outcomes 11,20 …”