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A Validated Score Predicts Acute Kidney Injury and Survival in Patients with Alcoholic Hepatitis: A Multicentric International Prospective Cohort Study.
Liver Transpl. 2018 Aug 28;:
Authors: Sujan R, Cruz-Lemini M, Altamirano J, Simonetto D, Maiwall R, Axley P, Richardson T, Desai V, Cabezas J, Vargas V, Kamath PS, Shah VH, Sarin SK, Bataller R, Singal AK
Abstract
BACKGROUND AND RATIONALE: Identifying patients at high risk for AKI during hospitalization among patients admitted with severe alcoholic hepatitis (AH0 is an unmet clinical need.
METHODS: We performed a multicentric prospective cohort study using data from four different cohorts on well-characterized patients hospitalized with severe AH.
RESULTS: Data collected on 773 AH patients from four cohorts across the globe was randomly split into test (n=390) and validation (n=383) cohorts. A total of 32% patients developed inpatient AKI in the test cohort. Approximately 60% patients met criteria for systemic inflammatory response syndrome (SIRS) at admission. Hepatic encephalopathy (HE), SIRS, and model for end-stage liver disease (MELD) score at admission predicted inpatient AKI, with odds ratios of 3.86, 2.24, and 1.14 respectively. The AKI risk score developed using these predictors stratified AKI risk to low (score <3), moderate (3-4), and high (>4) risk of inpatient AKI. These findings were replicated in the validation cohort. In the whole study cohort, patients with AKI had a lower 90-day survival (53% vs. 77%, p<0.001). Those with AKI risk score of >4 had significantly lower 90-day survival as compared to those with risk scores between 3 and 4 and <3 (47% vs. 68% vs. 88%, p<0.001).
CONCLUSION: AKI occurs frequently in AH patients and negatively impacts short-term mortality. The AKI risk score is useful in identifying patients at high risk for inpatient AKI, and may be useful for developing new therapeutic strategies to prevent AKI in patients with AH. This article is protected by copyright. All rights reserved.
PMID: 30153377 [PubMed - as supplied by publisher]