Acute Kidney Injury is an Early Predictor of Mortality for Patients with Alcoholic Hepatitis.
Clin Gastroenterol Hepatol. 2011 Sep 21;
Authors: Altamirano J, Fagundes C, Dominguez M, García E, Michelena J, Cárdenas A, Guevara M, Pereira G, Torres-Vigil K, Arroyo V, Caballería J, Ginès P, Bataller R
BACKGROUND & AIMS: Alcoholic hepatitis (AH) is a severe condition with high mortality. To improve therapeutic strategies, it is important to identify factors that affect survival times. The ABIC scoring system was previously developed to determine prognosis of patients with AH. We studied effects of the acute kidney injury (AKI) on survival of patients with AH. METHODS: We retrospectively analyzed data from 103 patients with biopsy-proven AH. AKI was defined as an abrupt reduction (within 48 h) in kidney function that resulted in an absolute increase of at least 0.3 mg/dl (or a 50% increase) in serum levels of creatinine (SCr) from baseline (the AKI network [AKIN] criteria). RESULTS: Twenty-nine patients (28%) developed AKI during hospitalization, with a median time to diagnosis of 3 days. Overall 90-day mortality was 23%, which was significantly higher among patients with AKI than those without (65% vs 7%; P<.0001). The ABIC score (P<.0001) and development of AKI (P<.0001) were the most accurate independent predictors of 90-day mortality. The presence of systemic inflammatory response syndrome (P<.0001), serum levels of bilirubin (P=.01), and international normalized ratio at admission (P=.03) were the most accurate predictors of AKI. Importantly, the AKIN criteria were more accurate than traditional criteria for renal failure (SCr >1.5 mg/dL) in predicting 90-day mortality (area under the receiver operating characteristic, 0.83 vs 0.70, respectively; P=.02). CONCLUSION: Development of AKI reduces survival of patients with AH, in the short term. The AKIN criteria are useful and more accurate than traditional criteria in predicting mortality. Strategies to prevent AKI should therefore be considered in the management of patients with AH.
PMID: 21946124 [PubMed - as supplied by publisher]