BACKGROUND AND AIM: Acute kidney injury (AKI) is a common complication in patients with liver cirrhosis, and its impact on the clinical course is increasingly recognized. Diagnostic classification systems for AKI in cirrhosis have been suggested. The prognostic significance of the respective AKI stages remains to be evaluated in decompensated cirrhosis with ascites. METHODS: Data of consecutive patients with cirrhosis and ascites undergoing paracentesis at a tertiary care center were analyzed. AKI was defined as an increase in serum creatinine of ≥ 0.3 mg/dL or by ≥ 50% within 7 days after paracentesis, and classified according to (i) revised Acute Kidney Injury Network (AKIN) criteria and (ii) modified AKI criteria for cirrhosis (C-AKI). In contrast to AKIN, C-AKI stage A discriminates prognosis based on an absolute creatinine cut-off at < 1.5 mg/dL versus C-AKI stage B at ≥ 1.5 mg/dL. RESULTS: The final study cohort included 239 patients. Median transplant-free survival was 768 days (95% confidence interval [CI]: 331-1205 days) without AKI, 198 (0-446) in AKI-1, 91 (0-225) in AKI-2, 19 (0-40) and in AKI-3, whereas it was 89 (20-158) days in C-AKI-A, 384 (0-1063) in C-AKI-B, and 22 (7-776) in C-AKI-C. Mild AKI was already associated with significantly increased 30-day mortality (AKI-1:26.4%, C-AKI-A:33.3%) as compared with patients without AKI (14.3%), even when serum creatinine remained within normal range (< 1.2 mg/dL) we observed a significant 30-day mortality. CONCLUSION: AKIN criteria-considering small increases in serum creatinine rather than absolute thresholds-seem to be more accurate for estimating prognosis of AKI after paracentesis than C-AKI criteria. Even patients developing AKI-1 with "normal" serum creatinine are at increased risk for mortality.
BACKGROUND AND AIM: Acute kidney injury (AKI) is a common complication in patients with liver cirrhosis, and its impact on the clinical course is increasingly recognized. Diagnostic classification systems for AKI in cirrhosis have been suggested. The prognostic significance of the respective AKI stages remains to be evaluated in decompensated cirrhosis with ascites. METHODS: Data of consecutive patients with cirrhosis and ascites undergoing paracentesis at a tertiary care center were analyzed. AKI was defined as an increase in serum creatinine of ≥ 0.3 mg/dL or by ≥ 50% within 7 days after paracentesis, and classified according to (i) revised Acute Kidney Injury Network (AKIN) criteria and (ii) modified AKI criteria for cirrhosis (C-AKI). In contrast to AKIN, C-AKI stage A discriminates prognosis based on an absolute creatinine cut-off at < 1.5 mg/dL versus C-AKI stage B at ≥ 1.5 mg/dL. RESULTS: The final study cohort included 239 patients. Median transplant-free survival was 768 days (95% confidence interval [CI]: 331-1205 days) without AKI, 198 (0-446) in AKI-1, 91 (0-225) in AKI-2, 19 (0-40) and in AKI-3, whereas it was 89 (20-158) days in C-AKI-A, 384 (0-1063) in C-AKI-B, and 22 (7-776) in C-AKI-C. Mild AKI was already associated with significantly increased 30-day mortality (AKI-1:26.4%, C-AKI-A:33.3%) as compared with patients without AKI (14.3%), even when serum creatinine remained within normal range (< 1.2 mg/dL) we observed a significant 30-day mortality. CONCLUSION: AKIN criteria-considering small increases in serum creatinine rather than absolute thresholds-seem to be more accurate for estimating prognosis of AKI after paracentesis than C-AKI criteria. Even patients developing AKI-1 with "normal" serum creatinine are at increased risk for mortality.
Authors: F Wong; J G O'Leary; K R Reddy; G Garcia-Tsao; M B Fallon; S W Biggins; R M Subramanian; P J Thuluvath; P S Kamath; H Patton; B Maliakkal; P Tandon; H Vargas; L Thacker; J S Bajaj Journal: Am J Gastroenterol Date: 2017-04-25 Impact factor: 10.864
Authors: Benedikt Simbrunner; Annika Röthenbacher; Helmuth Haslacher; David Bauer; David Chromy; Theresa Bucsics; Philipp Schwabl; Rafael Paternostro; Bernhard Scheiner; Michael Trauner; Mattias Mandorfer; Ilse Schwarzinger; Thomas Reiberger Journal: United European Gastroenterol J Date: 2019-04-05 Impact factor: 4.623
Authors: Joana Gameiro; José Agapito Fonseca; Joana Monteiro Dias; Maria João Melo; Sofia Jorge; José Velosa; José António Lopes Journal: Int J Nephrol Renovasc Dis Date: 2018-04-24
Authors: Georg Semmler; Bernhard Scheiner; Philipp Schwabl; Theresa Bucsics; Rafael Paternostro; David Chromy; Albert Friedrich Stättermayer; Michael Trauner; Mattias Mandorfer; Arnulf Ferlitsch; Thomas Reiberger Journal: PLoS One Date: 2019-11-06 Impact factor: 3.240
Authors: Georg Semmler; Benedikt Simbrunner; Bernhard Scheiner; Philipp Schwabl; Rafael Paternostro; Theresa Bucsics; Albert Friedrich Stättermayer; David Bauer; Matthias Pinter; Peter Ferenci; Michael Trauner; Mattias Mandorfer; Thomas Reiberger Journal: J Gastroenterol Hepatol Date: 2019-06-14 Impact factor: 4.029