Progression of Stage 2 and 3 Acute Kidney Injury in Patients with Decompensated Cirrhosis and Ascites

Link to article at PubMed

Clin Gastroenterol Hepatol. 2020 Aug 13:S1542-3565(20)31134-4. doi: 10.1016/j.cgh.2020.08.025. Online ahead of print.


BACKGROUND AND AIM: Progression of stage 2 and 3 AKI in cirrhosis has not been adequately characterized. Patients with higher stages of AKI are believed to have worse outcomes. We assessed outcomes and factors associated with stages 2 and 3 AKI in patients with cirrhosis in the North American Consortium for the Study of End-stage Liver Disease (NACSELD) cohort.

METHODS: We collected data from 2297 hospitalized patients with cirrhosis and ascites from December 2011 through February 2017. Our final analysis included 760 patients who developed AKI per the International Ascites Club 2015 definition (419 with maximum stage 1 and 341 with maximum stage 2 or 3; 63% male; mean age, 58 years). We compared demographic features, laboratory values, AKI treatment response and survival between patients with maximum stage 1 vs patients with stage 2 or 3 AKI.

RESULTS: Patients with stage 2 or 3 AKI had higher Model for End-Stage Liver Disease scores (25.9±7.3) than patients with stage 1 AKI (21.9±7.5) (p<0.0001). More patients fulfilled systemic inflammatory response syndrome criteria on admission, and more developed a second nosocomial infection (p<0.05 for both comparisons). More patients with stage 2 or 3 also had progression of AKI and required dialysis and admission into intensive care units (p<0.0001 for both). A lower proportion of patients with stage 2 or 3 AKI survived their hospital stay (80% vs. 99% with stage 1 AKI, p<0.0001), or survived for 30 days without a liver transplant (56% vs. 81%, p<0.0001). Stage 2 or 3 AKI was associated with higher Model for End-Stage Liver Disease score at time of admission (p<0.0001), presence of systemic inflammatory response on admission (p=0.039), and second infection (p<0.0001).

CONCLUSIONS: Based on an analysis of data from the North American Consortium for the Study of End-stage Liver Disease cohort, we found that patients with cirrhosis and more advanced liver disease as well as a second infection are more likely to develop stages 2 or 3 AKI, with a progressive course associated with decreased 30-day transplant-free survival. Prevention of AKI progression in patients with cirrhosis and stage 2 or 3 AKI might improve their outcomes.

PMID:32798707 | DOI:10.1016/j.cgh.2020.08.025

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