Shiran Shetty1, Shankar Prasad Nagaraju2, Srinivas Shenoy3, Ravindra Prabhu Attur3, Dharshan Rangaswamy3, Indu R Rao3, Uday Venkat Mateti4, Rajeevalochana Parthasarathy5. 1. Department of Gastroenterology, Kasturba Medical College, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, 576 104, India. 2. Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, 576 104, India. shankarmmcmed@gmail.com. 3. Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, 576 104, India. 4. Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte (Deemed to be University), Deralakatte, Mangaluru, 575 018, India. 5. Department of Nephrology, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai, 600 037, India.
Abstract
BACKGROUND: Acute kidney injury (AKI) is a common complication of liver cirrhosis and is associated with poor survival. We studied the clinical profile and predictors of in-hospital mortality in patients with cirrhosis of the liver with AKI. METHODS: This retrospective cohort study examined patients at a tertiary care hospital. AKI staging was done based on the new 2015 Ascites Club Criteria. Patients were grouped into three types of AKI: pre-renal azotemia (PRA), hepatorenal syndrome (HRS), and acute tubular necrosis (ATN). RESULTS: Data of 123 patients with cirrhosis and AKI were analyzed. Most patients had AKI stage 3 (57.7%). ATN (42.3%) and HRS (43.9) were the predominant types of AKI followed by PRA (13.8%). The overall in-hospital mortality in our study was 44.7%. The mortality increased with increasing severity of AKI (p = 0.0001) and was the highest in AKI stage 3 (p = 0.001) and those who required hemodialysis (p = 0.001). There was a significant in-hospital mortality in patients with ATN and HRS in comparison to PRA (p = 0.001). On multivariate analysis, the factors predicting in-hospital mortality were AKI stage 3, and oliguria (p = 0.0001). CONCLUSIONS: Acute kidney injury in cirrhosis of liver carries high in-hospital mortality. Pre-renal AKI has a better survival compared to ATN and HRS. The higher stage of AKI at presentation and the presence of oliguria are two important predictors of in-hospital mortality.
BACKGROUND:Acute kidney injury (AKI) is a common complication of liver cirrhosis and is associated with poor survival. We studied the clinical profile and predictors of in-hospital mortality in patients with cirrhosis of the liver with AKI. METHODS: This retrospective cohort study examined patients at a tertiary care hospital. AKI staging was done based on the new 2015 Ascites Club Criteria. Patients were grouped into three types of AKI: pre-renal azotemia (PRA), hepatorenal syndrome (HRS), and acute tubular necrosis (ATN). RESULTS: Data of 123 patients with cirrhosis and AKI were analyzed. Most patients had AKI stage 3 (57.7%). ATN (42.3%) and HRS (43.9) were the predominant types of AKI followed by PRA (13.8%). The overall in-hospital mortality in our study was 44.7%. The mortality increased with increasing severity of AKI (p = 0.0001) and was the highest in AKI stage 3 (p = 0.001) and those who required hemodialysis (p = 0.001). There was a significant in-hospital mortality in patients with ATN and HRS in comparison to PRA (p = 0.001). On multivariate analysis, the factors predicting in-hospital mortality were AKI stage 3, and oliguria (p = 0.0001). CONCLUSIONS:Acute kidney injury in cirrhosis of liver carries high in-hospital mortality. Pre-renal AKI has a better survival compared to ATN and HRS. The higher stage of AKI at presentation and the presence of oliguria are two important predictors of in-hospital mortality.
Entities:
Keywords:
Acute kidney injury; Cirrhosis of liver; Hepatorenal syndrome
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