Acute kidney injury in patients with cirrhosis: Prospective longitudinal study in 405 patients |
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| Institution: | 1. Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium;2. Department of Surgery and Abdominal Organ Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium;3. Department of Pathology, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium;4. Department of Hepatology, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate 1200 Woluwe Saint Lambert, Brussels, Belgium;1. Postgraduate School of Diagnostic and Interventional Radiology, University of Milan - Università degli Studi di Milano, Via Rodolfo Morandi 30, 20097 San Donato Milanese (MI), Italy;2. Unità Operativa di Endoscopia, Azienda Ospedaliera Santi Paolo e Carlo, Presidio San Paolo, Via di Rudinì 8, 20142 Milan, Italy;3. Unità Operativa di Chirurgia II, Azienda Ospedaliera Santi Paolo e Carlo, Presidio San Paolo, Via di Rudinì 8, 20142 Milan, Italy;4. Unità Operativa di Radiologia, ASST Fatebenefratelli Sacco, Via GB Grassi 74, 20157 Milan, Italy;1. Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China;2. Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China;1. Department of Pathology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China;2. Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China;3. Endoscopy Center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China;4. Department of Radiology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China;1. Department of Hepatobiliary and Pancreatic Surgery, The Third People''s Hospital of Yunnan Province, Yunnan, 650000, China;1. Médecine Sorbonne Université, Service d''Hépato-gastroentérologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l''Hôpital, Paris 75013, France;2. Inserm U1149, Centre de Recherche sur l''Inflammation, France Faculté de Médecine Xavier Bichat, Université Paris Diderot, Paris, France;3. Médecine Sorbonne Université, Service d''anatomopathologie, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France;4. Médecine Sorbonne Université, Service de Chirurgie Digestive et Hépato-Bilio-pancréatique – Transplantation Hépatique, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France |
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| Abstract: | BackgroundAcute kidney injury (AKI) is common in patients with cirrhosis. In 2015, the International Club of Ascites (ICA) proposed new definitions of AKI in order to improve the prediction of outcomes. Our aim was to assess the prevalence and prognostic value of ICA 2015 – AKI criteria in hospitalised patients with cirrhosis.MethodsWe prospectively collected data from 405 consecutive cirrhotic patients admitted to the hospital between November 2016 and November 2017. AKI was diagnosed at inclusion according to ICA 2015 criteria, and was assessed to predict 30-day and 90-day in-hospital mortality.ResultsAKI was diagnosed in 78 (19.3%) patients. AKI was independently associated with 90-day death (HR 7.61; 95% CI 4.75–12.19; p < 0.001). In hospital, 30-day and 90-day survival was lower in the group of patients with AKI compared to the group with no AKI (72% vs. 98%, p < 0.001; 64% vs. 96%, p < 0.001; and 49% vs. 81%, p < 0.001, respectively). Patients with stage 1a AKI had a lower 30-day and 90-day survival compared to the group of patients who did not develop AKI (71% vs. 96%, p < 0.001, and 71% vs. 91%, p < 0.01, respectively) and better survival than patients with more severe AKI (71% vs. 40%, p < 0.01).ConclusionsAKI was independently associated with mortality in patients with cirrhosis, even at the very early 1a stage. Response to treatment improved survival, and was inversely proportional to the stage of AKI, which suggests that treatment should be started at the earliest stage of AKI. |
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