Association of AKI With mortality and complications in hospitalized patients with cirrhosis§

Authors

  • Justin M. Belcher,

    1. Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
    2. Section of Nephrology, Yale University School of Medicine, New Haven, CT
    3. Clinical Epidemiology Research Center, VAMC, West Haven, CT
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  • Guadalupe Garcia-Tsao,

    1. Clinical Epidemiology Research Center, VAMC, West Haven, CT
    2. Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT
    3. VA-Connecticut Healthcare System, West Haven, CT
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  • Arun J. Sanyal,

    1. Division of Gastroenterology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
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  • Harjit Bhogal,

    1. Division of Gastroenterology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
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  • Joseph K. Lim,

    1. Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT
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  • Naheed Ansari,

    1. Division of Nephrology, Department of Internal Medicine, Jacobi Medical Center, South Bronx, NY
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  • Steven G. Coca,

    1. Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
    2. Section of Nephrology, Yale University School of Medicine, New Haven, CT
    3. Clinical Epidemiology Research Center, VAMC, West Haven, CT
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  • Chirag R. Parikh,

    Corresponding author
    1. Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
    2. Section of Nephrology, Yale University School of Medicine, New Haven, CT
    3. Clinical Epidemiology Research Center, VAMC, West Haven, CT
    • Section of Nephrology, Yale University and VAMC, 950 Campbell Avenue, Mail Code 151B, Building 35A, Room 219, West Haven, CT 06515
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    • fax: 203-937-4932

  • for the TRIBE-AKI Consortium

    1. Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT
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  • Potential conflict of interest: Nothing to report.

  • Supported by a grant from the National Institutes of Health (NIH) R21-DK078714 to Dr. Parikh. Dr. Belcher was supported by an institutional fellowship training grant from NIH.

  • §

    Collaborators: Isabel Butrymowicz, Aldo J. Peixoto, Mark A. Perazella.

  • See Editorial on Page 435

Abstract

Acute kidney injury (AKI) is a common and devastating complication in patients with cirrhosis. However, the definitions of AKI employed in studies involving patients with cirrhosis have not been standardized, lack sensitivity, and are often limited to narrow clinical settings. We conducted a multicenter, prospective observational cohort study of patients with cirrhosis and AKI, drawn from multiple hospital wards, utilizing the modern acute kidney injury network (AKIN) definition and assessed the association between AKI severity and progression with in-hospital mortality. Of the 192 patients who were enrolled and included in the study, 85 (44%) progressed to a higher AKIN stage after initially fulfilling AKI criteria. Patients achieved a peak severity of AKIN stage 1, 26%, stage 2, 24%, and stage 3, 49%. The incidence of mortality, general medical events (bacteremia, pneumonia, urinary tract infection), and cirrhosis-specific complications (ascites, encephalopathy, spontaneous bacterial peritonitis) increased with severity of AKI. Progression was significantly more common and peak AKI stage higher in nonsurvivors than survivors (P < 0.0001). After adjusting for baseline renal function, demographics, and critical hospital- and cirrhosis-associated variables, progression of AKI was independently associated with mortality (adjusted odds ratio = 3.8, 95% confidence interval 1.3-11.1). Conclusion: AKI, as defined by AKIN criteria, in patients with cirrhosis is frequently progressive and severe and is independently associated with mortality in a stage-dependent fashion. Methods for earlier diagnosis of AKI and its progression may result in improved outcomes by facilitating targeted and timely treatment of AKI. (HEPATOLOGY 2013)

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