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News

New consensus definition of acute kidney injury predicts mortality in cirrhosis

New consensus definition of acute kidney injury accurately predicts 30-Day mortality in patients with cirrhosis and infection, reports this month's issue of Gastroenterology.

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Participants at a consensus conference proposed defining cirrhosis-associated acute kidney injury (AKI) based on a >50% increase in serum creatinine level from the stable baseline value in <6 months or an increase of ≥0.3 mg/dL in <48 hours.

Dr Florence Wong and colleagues from Canada 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.

The researchers followed up 337 patients with cirrhosis who were admitted to the hospital with an infection or developed an infection during hospitalization at 12 centers in North America.

The team compared data on 30-day mortality, length of stay in the hospital, and organ failure between patients with and without AKI.

In total, based on the consensus criteria, 49% of patients developed AKI during hospitalization.

Patients who developed AKI were admitted with higher Child–Pugh scores than those who did not develop AKI as well as higher MELD scores, and lower mean arterial pressure.

Higher percentages of patients with AKI died within 30 days of hospitalization, were transferred to the intensive care unit, required ventilation, or went into shock.

The team found that patients with AKI also had longer stays in the hospital.

Of the AKI episodes, the research team observed that 56% were transient, 28% were persistent, and 16% resulted in dialysis.

Mortality was higher among those without renal recovery compared with partial or complete recovery or those who did not develop AKI.

Dr Wong's team comments, "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."

Gastroenterology 2013: 145(6): 1280-1288.e1
04 December 2013

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