Acute kidney injury in patients with cirrhosis of liver: Clinical profile and predictors of outcome

Indian J Gastroenterol. 2018 May;37(3):248-254. doi: 10.1007/s12664-018-0867-4. Epub 2018 Jul 17.

Abstract

Background: Acute kidney injury (AKI) is a common complication of liver cirrhosis and is associated with poor survival. We studied the clinical profile and predictors of in-hospital mortality in patients with cirrhosis of the liver with AKI.

Methods: This retrospective cohort study examined patients at a tertiary care hospital. AKI staging was done based on the new 2015 Ascites Club Criteria. Patients were grouped into three types of AKI: pre-renal azotemia (PRA), hepatorenal syndrome (HRS), and acute tubular necrosis (ATN).

Results: Data of 123 patients with cirrhosis and AKI were analyzed. Most patients had AKI stage 3 (57.7%). ATN (42.3%) and HRS (43.9) were the predominant types of AKI followed by PRA (13.8%). The overall in-hospital mortality in our study was 44.7%. The mortality increased with increasing severity of AKI (p = 0.0001) and was the highest in AKI stage 3 (p = 0.001) and those who required hemodialysis (p = 0.001). There was a significant in-hospital mortality in patients with ATN and HRS in comparison to PRA (p = 0.001). On multivariate analysis, the factors predicting in-hospital mortality were AKI stage 3, and oliguria (p = 0.0001).

Conclusions: Acute kidney injury in cirrhosis of liver carries high in-hospital mortality. Pre-renal AKI has a better survival compared to ATN and HRS. The higher stage of AKI at presentation and the presence of oliguria are two important predictors of in-hospital mortality.

Keywords: Acute kidney injury; Cirrhosis of liver; Hepatorenal syndrome.

Publication types

  • Observational Study

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / mortality
  • Cohort Studies
  • Female
  • Forecasting
  • Hospital Mortality
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / mortality
  • Male
  • Middle Aged
  • Oliguria
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate