BACKGROUND & AIMS:
Participants at a consensus conference proposed that cirrhosis-associated acute kidney injury (AKI) be defined based on an increase serum level of creatinine by >50% from the stable baseline value in <6 months or by ≥0.3 mg/dL in <48 hrs. We performed a prospective study to evaluate the ability of these criteria to predict mortality within 30 days of hospitalization among patients with cirrhosis and infection.
We followed 337 patients with cirrhosis who were admitted to the hospital with an infection or developed one during hospitalization (56% men; 56±10 y old; model for end-stage liver disease [MELD] score, 20±8) at 12 centers in North America. We compared data on 30-day mortality, length-of-stay in the hospital, and organ failure between patients with and without AKI.
Of the patients, 166 (49%) developed AKI during hospitalization, based on the consensus criteria. Patients who developed AKI were admitted with higher Child-Pugh scores than those who did not develop AKI (11.0±2.1 vs 9.6±2.1; P<.0001), as well as higher MELD scores (23±8 vs17±7; P<.0001) and lower mean arterial pressure (81±16 mm Hg vs 85±15 mm Hg; P<.01). Higher percentages of patients with AKI died within 30 days of hospitalization (34% vs 7%), were transferred to the intensive care unit (46% vs 20%), required ventilation (27% vs 6%), or went into shock (31% vs 8%); patients with AKI also had longer stays in the hospital (17.8±19.8 days vs 13.3±31.8 days) (all P<.001). Of AKI episodes, 56% were transient, 28% persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%), compared to partial (40%) or complete recovery (15%), or those who did not develop AKI (7%; P<.0001).
Among patients with cirrhosis, 30-day mortality is 10-fold higher among those with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure.