New Consensus Definition of Acute Kidney Injury Accurately Predicts 30-day Mortality in Patients with Cirrhosis with Infection.

Link to article at PubMed

New Consensus Definition of Acute Kidney Injury Accurately Predicts 30-day Mortality in Patients with Cirrhosis with Infection.

Gastroenterology. 2013 Aug 30;

Authors: Wong F, O'Leary JG, Reddy KR, Patton H, Kamath PS, Fallon MB, Garcia-Tsao G, Subramanian RM, Malik R, Maliakkal B, Thacker LR, Bajaj JS

Abstract
BACKGROUND & AIMS: Participants at a consensus conference proposed that cirrhosis-associated acute kidney injury (AKI) be defined based on an increase serum level of creatinine by >50% from the stable baseline value in <6 months or by ≥0.3 mg/dL in <48 hrs. 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.
METHODS: We followed 337 patients with cirrhosis who were admitted to the hospital with an infection or developed one during hospitalization (56% men; 56±10 y old; 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.
RESULTS: Of the patients, 166 (49%) developed AKI during hospitalization, based on the consensus criteria. 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 vs17±7; P<.0001) and lower mean arterial pressure (81±16 mm Hg 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 days vs 13.3±31.8 days) (all P<.001). Of AKI episodes, 56% were transient, 28% persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%), compared to partial (40%) or complete recovery (15%), or those who did not develop AKI (7%; P<.0001).
CONCLUSIONS: 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.

PMID: 23999172 [PubMed - as supplied by publisher]

Leave a Reply

Your email address will not be published. Required fields are marked *