Anantha Nuthalapati1, Nicholas Schluterman2, Anuj Khanna1, Deborah Greenberg2, Paul J Thuluvath1,3. 1. The Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, United States. 2. Department of Epidemiology and Public Health, the University of Maryland School of Medicine, Baltimore, United States. 3. Department of Medicine and Surgery, the University of Maryland School of Medicine, Baltimore, United States.
Abstract
BACKGROUND/AIMS: The mortality of hospitalized patients for complications of cirrhosis is very high. We examined the independent predictors of mortality, particularly the impact of increments in creatinine, in 339 consecutive patients (636 admissions) who were admitted for complications of cirrhosis. METHODS: Clinical characteristics, biochemical parameters including serum creatinine levels at various time intervals, and mortality data were recorded for all admissions. Data were analyzed for initial as well for all repeated admissions to identify independent predictors of mortality. RESULTS: The in-hospital mortality, 30-day, 90-day, 180 days, and 365 days mortality were 6%, 15%, 23%, 30%, and 41% respectively. Those admitted with spontaneous bacterial peritonitis had the worst survival. Increase in creatinine was noted in 29% of patients and they had lower 30-day (78% vs.91%) and 90-day (73% vs. 82%) survival than those without increase in creatinine. Any increment in serum creatinine (≥0.1 mg/dL) within 48 h after admission (peak 48 h - admission) was associated with a step-wise increase in mortality, but only if peak creatinine reached above 1.2 mg/dL. If peak creatinine levels were below 1.2 mg/dL, increases in serum creatinine had no impact on survival. Cox regression analysis showed that increments in serum creatinine of 0.3 mg/dL or higher had the worst outcome (HR 2.51, CI 1.65-3.81). Etiology of cirrhosis or the use of PPI, beta blockers or rifaxamin did not predict mortality. Other independent predictors of mortality were age, reason for admission, hyponatremia, and INR. CONCLUSION: In patients with cirrhosis, any increment in serum creatinine within 48 h from hospitalization is associated with a higher mortality provided the peak serum creatinine within 48 h is above 1.2 mg/dL.
BACKGROUND/AIMS: The mortality of hospitalized patients for complications of cirrhosis is very high. We examined the independent predictors of mortality, particularly the impact of increments in creatinine, in 339 consecutive patients (636 admissions) who were admitted for complications of cirrhosis. METHODS: Clinical characteristics, biochemical parameters including serum creatinine levels at various time intervals, and mortality data were recorded for all admissions. Data were analyzed for initial as well for all repeated admissions to identify independent predictors of mortality. RESULTS: The in-hospital mortality, 30-day, 90-day, 180 days, and 365 days mortality were 6%, 15%, 23%, 30%, and 41% respectively. Those admitted with spontaneous bacterial peritonitis had the worst survival. Increase in creatinine was noted in 29% of patients and they had lower 30-day (78% vs.91%) and 90-day (73% vs. 82%) survival than those without increase in creatinine. Any increment in serum creatinine (≥0.1 mg/dL) within 48 h after admission (peak 48 h - admission) was associated with a step-wise increase in mortality, but only if peak creatinine reached above 1.2 mg/dL. If peak creatinine levels were below 1.2 mg/dL, increases in serum creatinine had no impact on survival. Cox regression analysis showed that increments in serum creatinine of 0.3 mg/dL or higher had the worst outcome (HR 2.51, CI 1.65-3.81). Etiology of cirrhosis or the use of PPI, beta blockers or rifaxamin did not predict mortality. Other independent predictors of mortality were age, reason for admission, hyponatremia, and INR. CONCLUSION: In patients with cirrhosis, any increment in serum creatinine within 48 h from hospitalization is associated with a higher mortality provided the peak serum creatinine within 48 h is above 1.2 mg/dL.
Authors: Douglas M Heuman; Souheil G Abou-Assi; Adil Habib; Leslie M Williams; R Todd Stravitz; Arun J Sanyal; Robert A Fisher; Anastasios A Mihas Journal: Hepatology Date: 2004-10 Impact factor: 17.425
Authors: José António Lopes; Maria João Melo; Ana Cortesão Costa; Mário Raimundo; Paula Alexandrino; António Gomes da Costa; José Velosa Journal: Gut Date: 2011-10-13 Impact factor: 23.059
Authors: Florence Wong; Jacqueline G O'Leary; K Rajender Reddy; Heather Patton; Patrick S Kamath; Michael B Fallon; Guadalupe Garcia-Tsao; Ram M Subramanian; Raza Malik; Benedict Maliakkal; Leroy R Thacker; Jasmohan S Bajaj Journal: Gastroenterology Date: 2013-08-30 Impact factor: 22.682
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097
Authors: You Hyun Jeon; Il Young Kim; Gum Sook Jang; Sang Heon Song; Eun Young Seong; Dong Won Lee; Soo Bong Lee; Hyo Jin Kim Journal: Kidney Res Clin Pract Date: 2021-08-11