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Erschienen in: Indian Journal of Gastroenterology 3/2018

17.07.2018 | Original Article

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

verfasst von: Shiran Shetty, Shankar Prasad Nagaraju, Srinivas Shenoy, Ravindra Prabhu Attur, Dharshan Rangaswamy, Indu R. Rao, Uday Venkat Mateti, Rajeevalochana Parthasarathy

Erschienen in: Indian Journal of Gastroenterology | Ausgabe 3/2018

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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.
Literatur
2.
Zurück zum Zitat D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–31.CrossRefPubMed D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–31.CrossRefPubMed
3.
Zurück zum Zitat Du Cheyron D, Bouchet B, Parienti JJ, Ramakers M, Charbonneau P. The attributable mortality of acute renal failure in critically ill patients with liver cirrhosis. Intensive Care Med. 2005;31:1693–9.CrossRefPubMed Du Cheyron D, Bouchet B, Parienti JJ, Ramakers M, Charbonneau P. The attributable mortality of acute renal failure in critically ill patients with liver cirrhosis. Intensive Care Med. 2005;31:1693–9.CrossRefPubMed
5.
Zurück zum Zitat Bucsics T, Krones E. Renal dysfunction in cirrhosis: acute kidney injury and the hepatorenal syndrome. Gastroenterol Rep (Oxf). 2017;5:127–37.CrossRef Bucsics T, Krones E. Renal dysfunction in cirrhosis: acute kidney injury and the hepatorenal syndrome. Gastroenterol Rep (Oxf). 2017;5:127–37.CrossRef
6.
Zurück zum Zitat Angeli P, Gine’s P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. J Hepatol. 2015;62:968–74.CrossRefPubMed Angeli P, Gine’s P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. J Hepatol. 2015;62:968–74.CrossRefPubMed
7.
Zurück zum Zitat Angeli P, Gatta A, Caregaro L, et al. Tubular site of renal sodium retention in ascitic liver cirrhosis evaluated by lithium clearance. Eur J Clin Invest. 1990;20:111–7. Angeli P, Gatta A, Caregaro L, et al. Tubular site of renal sodium retention in ascitic liver cirrhosis evaluated by lithium clearance. Eur J Clin Invest. 1990;20:111–7.
8.
Zurück zum Zitat Kumar T. Incidence of cirrhosis caused by hepatitis B virus in different sex and age groups in Bihar. J MGIMS. 2006;11:52–4. Kumar T. Incidence of cirrhosis caused by hepatitis B virus in different sex and age groups in Bihar. J MGIMS. 2006;11:52–4.
9.
Zurück zum Zitat Joshi PH. Chronic hepatitis ‘B’. Bombay Hosp J. 1996;3804:701. Joshi PH. Chronic hepatitis ‘B’. Bombay Hosp J. 1996;3804:701.
10.
Zurück zum Zitat Sarin SK, Guptan RC, Banerjee K, Khandekar P. Low prevalence of hepatitis C viral infection in patients with non-alcoholic chronic liver disease in India. J Assoc Physicians India. 1996;44:243–5.PubMed Sarin SK, Guptan RC, Banerjee K, Khandekar P. Low prevalence of hepatitis C viral infection in patients with non-alcoholic chronic liver disease in India. J Assoc Physicians India. 1996;44:243–5.PubMed
11.
Zurück zum Zitat Watt K, Uhanova J, Minuk GY. Hepatorenal syndrome: diagnostic accuracy, clinical features and outcome in a tertiary care centre. Am J Gastroenterol. 2002;97:2046–50.CrossRefPubMed Watt K, Uhanova J, Minuk GY. Hepatorenal syndrome: diagnostic accuracy, clinical features and outcome in a tertiary care centre. Am J Gastroenterol. 2002;97:2046–50.CrossRefPubMed
12.
Zurück zum Zitat Moreau R, Durand F, Poynard T, et al. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology. 2002;122:923–30. Moreau R, Durand F, Poynard T, et al. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology. 2002;122:923–30.
13.
Zurück zum Zitat Ginès A, Escorsell A, Ginès P, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993;105:229–36. Ginès A, Escorsell A, Ginès P, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993;105:229–36.
14.
Zurück zum Zitat Allegretti AS, Ortiz G, Wenger J, et al. Prognosis of acute kidney injury and hepatorenal syndrome in patients with cirrhosis: a prospective cohort study. Int J Nephrol. 2015;2015:108139.CrossRefPubMedPubMedCentral Allegretti AS, Ortiz G, Wenger J, et al. Prognosis of acute kidney injury and hepatorenal syndrome in patients with cirrhosis: a prospective cohort study. Int J Nephrol. 2015;2015:108139.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Alessandria C, Ozdogan O, Guevara M, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology. 2005;41:1282–9. Alessandria C, Ozdogan O, Guevara M, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology. 2005;41:1282–9.
16.
Zurück zum Zitat D’Amico G, Morabito A, Pagliaro L, Marubini E. Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci. 1986;31:468–75.CrossRefPubMed D’Amico G, Morabito A, Pagliaro L, Marubini E. Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci. 1986;31:468–75.CrossRefPubMed
17.
Zurück zum Zitat Martín-Llahí M, Guevara M, Torre A, et al. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology. 2011;140:488–96.e4.CrossRefPubMed Martín-Llahí M, Guevara M, Torre A, et al. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology. 2011;140:488–96.e4.CrossRefPubMed
Metadaten
Titel
Acute kidney injury in patients with cirrhosis of liver: Clinical profile and predictors of outcome
verfasst von
Shiran Shetty
Shankar Prasad Nagaraju
Srinivas Shenoy
Ravindra Prabhu Attur
Dharshan Rangaswamy
Indu R. Rao
Uday Venkat Mateti
Rajeevalochana Parthasarathy
Publikationsdatum
17.07.2018
Verlag
Springer India
Erschienen in
Indian Journal of Gastroenterology / Ausgabe 3/2018
Print ISSN: 0254-8860
Elektronische ISSN: 0975-0711
DOI
https://doi.org/10.1007/s12664-018-0867-4

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