Shubham Jain1, Suhas Udgirkar1, Pravin M Rathi1, Ravi Thanage1, Prasanta Debnath1, Parmeshwar Junare1, Sanjay Chandnani1, Qais Q Contractor1
1TNMC & BYL Nair Ch. Hospital
Background/Aims: Background: Acute kidney injury (AKI) occurs in 20-50% of patients with cirrhosis and is associated with a poor prognosis.
Aim. To identify the baseline factors affecting mortality in these patients at 30 and 90 days.
Methods: Between January 2017 and January 2019, 118 patients of cirrhosis with AKI were admitted and enrolled. Clinical and laboratory data were collected at diagnosis.
Results: The average age was 47.71 ± 12.32 years and males were 87 (73.7%). The average Child-Turcotte-Pugh and model for end-stage liver disease scores were 9.11 ± 1.25, and 18.51 ± 6.78 respectively. Distribution of International club of ascites AKI stages was: 26 (22.03%) stage 1 AKI, 59 (50%) stage 2 AKI, 33 (28%) stage 3 AKI. Mortalities at 30 and 90 days were 27 (22.8%) and 33 (27.9%) respectively. On multivariate analysis, variables affecting mortality at 30 days were serum creatinine level >2 mg% at 48 hours after AKI development (Adjusted OR 7.93, P=0.02) and leucocytosis (total leucocyte count>11,000/mm3) at admission (Adjusted OR 6.54, P=0.002). Only leucocytosis at admission was a predictor of 90 days mortality (Adjusted OR 4.76, P=0.01). Though not statistically significant, patients not responding to standard medical treatment had 3 times higher mortality at 30 days (adjusted OR 2.93, P=0.089), while maximum AKI stage (2 and 3) had 8 times higher mortality at 90 days (Adjusted OR 8.37, P=0.058).
Conclusion: In cirrhosis, AKI increases short-term mortality. High serum creatinine at 48 hours affects mortality at 30 days, while leucocytosis at baseline predicts mortality at 30 and 90 days.
Keywords: acute kidney injury; , chronic liver disease, hepatorenal syndrome