New Consensus Definition of Acute Kidney Injury Accurately Predicts 30-Day Mortality in Patients With Cirrhosis and Infection

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 145; no. 6; pp. 1280 - 1288.e1
• Main Authors: Wong, Florence, O'Leary, Jacqueline G., Reddy, K. Rajender, Patton, Heather, Kamath, Patrick S., Fallon, Michael B., Garcia–Tsao, Guadalupe, Subramanian, Ram M., Malik, Raza, Maliakkal, Benedict, Thacker, Leroy R., Bajaj, Jasmohan S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2013
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Aged; Bacterial Infection; Biomarkers - blood; Comorbidity; Consensus; Creatinine - blood; Female; Follow-Up Studies; Gastroenterology and Hepatology; Hepatorenal Syndrome; Humans; Length of Stay; Liver Cirrhosis - epidemiology; Liver Cirrhosis - mortality; Liver Fibrosis; Male; MELD; Middle Aged; Organ Dysfunction Scores; Prospective Studies; Survival Rate; SBP; Liver Fibrosis; LOS; MELD; ADQI; Bacterial Infection; Hepatorenal Syndrome; HRS; UTI; MAP; AKI; Acute Dialysis Quality Initiative; Model for End-Stage Liver Disease; mean arterial pressure; length of stay; acute kidney injury; spontaneous bacterial peritonitis; urinary tract infection
• ISSN: 0016-5085; 1528-0012; 1528-0012
• DOI: 10.1053/j.gastro.2013.08.051

Participants at a consensus conference proposed defining cirrhosis-associated acute kidney injury (AKI) based on a >50% increase in serum creatinine level from the stable baseline value in <6 months or an increase of ≥0.3 mg/dL in <48 hours. We performed a prospective study to evaluate the ability of these criteria to predict mortality within 30 days of hospitalization among patients with cirrhosis and infection. We followed up 337 patients with cirrhosis who were admitted to the hospital with an infection or developed an infection during hospitalization (56% men; 56 ± 10 years of age; Model for End-Stage Liver Disease [MELD] score, 20 ± 8) at 12 centers in North America. We compared data on 30-day mortality, length of stay in the hospital, and organ failure between patients with and without AKI. In total, based on the consensus criteria, 166 patients (49%) developed AKI during hospitalization. Patients who developed AKI were admitted with higher Child–Pugh scores than those who did not develop AKI (11.0 ± 2.1 vs 9.6 ± 2.1; P < .0001) as well as higher MELD scores (23 ± 8 vs 17 ± 7; P < .0001) and lower mean arterial pressure (81 ± 16 vs 85 ± 15 mm Hg; P < .01). Higher percentages of patients with AKI died within 30 days of hospitalization (34% vs 7%), were transferred to the intensive care unit (46% vs 20%), required ventilation (27% vs 6%), or went into shock (31% vs 8%); patients with AKI also had longer stays in the hospital (17.8 ± 19.8 vs 13.3 ± 31.8 days) (all P < .001). Of the AKI episodes, 56% were transient, 28% were persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%) compared with partial (40%) or complete recovery (15%) or those who did not develop AKI (7%; P < .0001). Among patients with cirrhosis, 30-day mortality is 10-fold higher among those with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure.