Background: To evaluate the incidence, risk factors, and outcomes of acute kidney injury (AKI) in patients with decompensated cirrhosis based on the Kidney Disease: Improving Global Outcomes Clinical Practice Guideline.
Methods: For this retrospective analysis, 923 inpatients were recruited between January 2013 and December 2017. The patients' baseline demographics and clinical information were collected and analyzed. Univariate and multiple logistic regression analyses were conducted to determine the independent risk factors for AKI and in-hospital mortality. Kaplan-Meier survival analyses were used to analyze the between-group differences in mortality.
Results: Of the 923 patients, 262 (28.39%) developed AKI. According to the multivariate analysis, an age ≥65 years (odds ratio [OR]: 1.776, 95% confidence interval [CI]: 1.288-2.449, p < 0.001), infection (OR: 1.386, 95% CI: 1.024-1.875, p = 0.034), hypotension (OR: 1.709, 95% CI: 1.091-2.679, p = 0.019), white blood cell count >10 × 109 /L (OR: 4.054, 95% CI: 2.006-8.193, p < 0.001), albumin concentration <35 g/L (OR: 1.931, 95% CI: 1.392-2.680, p < 0.001), baseline serum creatinine concentration >88.4 µmol/L (OR: 2.136, 95% CI: 1.511-3.021, p < 0.001), estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 (OR: 2.384, 95% CI: 1.372-4.145, p = 0.002), and serum sodium concentration <135 mmol/L (OR: 1.686, 95% CI: 1.155-2.459, p = 0.007) were independent risk factors for AKI. Moreover, AKI was significantly associated with in-hospital mortality (OR: 6.934, 95% CI: 1.333-11.052, p = 0.021). Kaplan-Meier survival analysis confirmed that patients with AKI had higher in-hospital mortality than those without AKI.
Conclusions: The incidence of AKI was high among patients with decompensated cirrhosis. Infection, an elevated baseline serum creatinine concentration, and decreased eGFR were independent risk factors for both AKI and in-hospital mortality. AKI was an independent risk factor for in-hospital mortality. Based on the risk factors identified, AKI prediction models and treatment approaches care bundles can be used for the early identification and modification of potential predisposing factors and for improving outcomes in these patients in the future.
Keywords: acute kidney injury; decompensated cirrhosis; incidence; mortality; risk factors.