Changing epidemiology and outcomes of acute kidney injury in hospitalized patients with cirrhosis - a US population-based study.
J Hepatol. 2020 May 06;:
Authors: Desai AP, Knapp SM, Orman ES, Ghabril MS, Nephew LD, Anderson M, Ginès P, Chalasani NP, Patidar KR
BACKGROUND & AIMS: Acute kidney injury (AKI) is a significant clinical event in cirrhosis yet contemporary population-based studies on the impact of AKI on hospitalized cirrhotics are lacking. We aimed to characterize longitudinal trends in incidence, healthcare burden and outcomes of hospitalized cirrhotics with and without AKI using a nationally representative dataset.
METHODS: Using the 2004-2016 National Inpatient Sample (NIS), admissions for cirrhosis with and without AKI were identified using International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes. Regression analysis was used to analyze the trends in hospitalizations, costs, length of stay (LOS) and inpatient mortality. Descriptive statistics, simple and multivariable logistic regression were used to assess associations between individual characteristics, comorbidities, and cirrhosis complications with AKI and death.
RESULTS: In over 3.6 million admissions for cirrhosis, 22% had AKI. AKI admissions were more costly (median $13127, IQR $7367-$24891 vs. $8079, IQR $4956, $13693) and longer (median 6 days, IQR 3-11 vs. 4 days, IQR 2-7). Over time, AKI prevalence doubled from 15% in 2004 to 30% in 2016. CKD was independently and strongly associated with AKI (AOR 3.75, 95% CI 3.72, 3.77). Importantly, AKI admissions were 3.75 times more likely to result in death (AOR 3.75 95% CI 3.71, 3.79) and presence of AKI increased risk of mortality in key subgroups of cirrhosis such as those with infections and portal hypertension-related complications.
CONCLUSIONS: There is a significant increase in AKI prevalence among hospitalized cirrhotics. AKI substantially increases the healthcare burden associated with cirrhosis. Despite advances in cirrhosis care, a significant gap remains in outcomes between cirrhotics with and without AKI, suggesting that AKI continues to represent a major clinical challenge. (Word count: 274).
PMID: 32387698 [PubMed - as supplied by publisher]