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Acute Kidney Injury Predicts Mortality in Cirrhosis with Infection

Summary and Comment |
January 3, 2014

Acute Kidney Injury Predicts Mortality in Cirrhosis with Infection

  1. Atif Zaman, MD, MPH

This newly redefined indicator successfully identified patients at higher risk for organ failure and mortality among a group hospitalized with bacterial infections.

  1. Atif Zaman, MD, MPH

Renal function is a strong prognostic marker in patients with cirrhosis. Even small increases in creatinine in this population can reflect renal dysfunction. Recently, acute kidney injury (AKI) in patients with cirrhosis was redefined using a lower threshold for renal dysfunction (increase in serum creatinine level of ≥0.3 mg/dL in <48 hours or a 50% increase in creatinine from a stable baseline). Now, investigators have prospectively evaluated whether the new AKI definition is useful in predicting outcomes in a high-risk group of patients with cirrhosis: those hospitalized with bacterial infection.

Among 337 patients in 12 participating centers, 166 fulfilled criteria for AKI. After adjustment for the Model for End-Stage Liver Disease score, in comparison with patients without AKI, those with AKI had a higher 30-day mortality rate (34% vs. 7%; P<0.0001), a longer hospital stay (mean number of days, 17.8 vs. 13.3; P<0.0001), and a higher rate of new organ failure (77% vs. 46%; P=0.0003). Among patients with AKI, injury was transient in 56%, persistent in 28%, and required dialysis in 16%. The mortality rate was 80% among those without renal recovery.

Comment

These results show a strong association between acute kidney injury and mortality in patients with cirrhosis and infection. Even a relatively small increase of creatinine of 0.3 mg/dL is associated with poor outcomes, including new organ failure and high mortality. Clinicians should aggressively treat even modest rise in creatinine from baseline with measures such as volume repletion and holding diuretics. Subsequent studies should evaluate the impact of early recognition and management of AKI in patients with cirrhosis and infection.

  • Disclosures for Atif Zaman, MD, MPH at time of publication Speaker’s bureau Bristol-Myers Squibb; Genentech; Gilead; Kadmon; Merck; Salix; Vertex

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Reader Comments (2)

jennifer

and cerebral complications, non-cardiac surgery, urate metabolism and renal function, arrhythmias,
pregnancy ... Patients with complex heart disease and Eisenmenger reaction had earlier clinical
deterioration (18·6 ... follow-up, mainly by sudden death (29·5%), heart failure (22·9

VINCENZA PETKOUSEK Other Healthcare Professional, Family Medicine/General Practice

Stats noted.

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