Impact of Acute Kidney Injury on Mortality of Patients Hospitalized for Complications of Cirrhosis

Anantha Nuthalapati; Nicholas Schluterman; Anuj Khanna; Deborah Greenberg; Paul J Thuluvath

doi:10.1016/j.jceh.2017.05.004

Impact of Acute Kidney Injury on Mortality of Patients Hospitalized for Complications of Cirrhosis

J Clin Exp Hepatol. 2017 Dec;7(4):290-299. doi: 10.1016/j.jceh.2017.05.004. Epub 2017 May 13.

Authors

Anantha Nuthalapati¹, Nicholas Schluterman², Anuj Khanna¹, Deborah Greenberg², Paul J Thuluvath^{1

3}

Affiliations

¹ The Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, United States.
² Department of Epidemiology and Public Health, the University of Maryland School of Medicine, Baltimore, United States.
³ Department of Medicine and Surgery, the University of Maryland School of Medicine, Baltimore, United States.

Abstract

Background/aims: The mortality of hospitalized patients for complications of cirrhosis is very high. We examined the independent predictors of mortality, particularly the impact of increments in creatinine, in 339 consecutive patients (636 admissions) who were admitted for complications of cirrhosis.

Methods: Clinical characteristics, biochemical parameters including serum creatinine levels at various time intervals, and mortality data were recorded for all admissions. Data were analyzed for initial as well for all repeated admissions to identify independent predictors of mortality.

Results: The in-hospital mortality, 30-day, 90-day, 180 days, and 365 days mortality were 6%, 15%, 23%, 30%, and 41% respectively. Those admitted with spontaneous bacterial peritonitis had the worst survival. Increase in creatinine was noted in 29% of patients and they had lower 30-day (78% vs.91%) and 90-day (73% vs. 82%) survival than those without increase in creatinine. Any increment in serum creatinine (≥0.1 mg/dL) within 48 h after admission (peak 48 h - admission) was associated with a step-wise increase in mortality, but only if peak creatinine reached above 1.2 mg/dL. If peak creatinine levels were below 1.2 mg/dL, increases in serum creatinine had no impact on survival. Cox regression analysis showed that increments in serum creatinine of 0.3 mg/dL or higher had the worst outcome (HR 2.51, CI 1.65-3.81). Etiology of cirrhosis or the use of PPI, beta blockers or rifaxamin did not predict mortality. Other independent predictors of mortality were age, reason for admission, hyponatremia, and INR.

Conclusion: In patients with cirrhosis, any increment in serum creatinine within 48 h from hospitalization is associated with a higher mortality provided the peak serum creatinine within 48 h is above 1.2 mg/dL.

Keywords: ADQI, Acute Dialysis Quality Initiative (ADQI); AKI, acute kidney injury; AKIN, acute kidney injury network; HRS, hepatorenal syndrome; INR, international normalized ratio; MELD, model for end-stage liver disease; PPI, proton pump inhibitor; SBP, spontaneous bacterial peritonitis; acute kidney injury; cirrhosis; complications of cirrhosis; hospitalized patients; liver failure.