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Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis.
Gut 2015; 64(10):1616-22Gut

Abstract

OBJECTIVE

Prognostic stratification of patients with cirrhosis is common clinical practice. This study compares the prognostic accuracy (28-day and 90-day transplant-free mortality) of the acute-on-chronic liver failure (ACLF) classification (no ACLF, ACLF grades 1, 2 and 3) with that of acute kidney injury (AKI) classification (no AKI, AKI stages 1, 2 and 3).

DESIGN

The study was performed in 510 patients with an acute decompensation of cirrhosis previously included in the European Association for the Study of the Liver-Chronic Liver Failure consortium CANONIC study. ACLF was evaluated at enrollment and 48 h after enrollment, and AKI was evaluated at 48 h according to Acute Kidney Injury Network criteria.

RESULTS

240 patients (47.1%) met the criteria of ACLF at enrollment, while 98 patients (19.2%) developed AKI. The presence of ACLF and AKI was strongly associated with mortality. 28-day transplant-free mortality and 90-day transplant-free mortality of patients with ACLF (32% and 49.8%, respectively) were significantly higher with respect to those of patients without ACLF (6.2% and 16.4%, respectively; both p<0.001). Corresponding values in patients with and without AKI were 46% and 59%, and 12% and 25.6%, respectively (p<0.0001 for both). ACLF classification was more accurate than AKI classification in predicting 90-day mortality (area under the receiving operating characteristic curve=0.72 vs 0.62; p<0.0001) in the whole series of patients. Moreover, assessment of ACLF classification at 48 h had significantly better prognostic accuracy compared with that of both AKI classification and ACLF classification at enrollment.

CONCLUSIONS

ACLF stratification is more accurate than AKI stratification in the prediction of short-term mortality in patients with acute decompensation of cirrhosis.

Authors+Show Affiliations

Department of Medicine (DIMED), University of Padova, Italy Unit of Hepatic Emergencies and Liver Transplantation, Padova, Italy.Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Fundación Renal Iñigo Alvarez de Toledo, (FRIAT), Madrid, Spain.Department of Medicine (DIMED), University of Padova, Italy Unit of Hepatic Emergencies and Liver Transplantation, Padova, Italy.Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Fundación Renal Iñigo Alvarez de Toledo, (FRIAT), Madrid, Spain.Department of Medicine (DIMED), University of Padova, Italy Unit of Hepatic Emergencies and Liver Transplantation, Padova, Italy.Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Fundación Renal Iñigo Alvarez de Toledo, (FRIAT), Madrid, Spain Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.Department of Medicine (DIMED), University of Padova, Italy Unit of Hepatic Emergencies and Liver Transplantation, Padova, Italy.Data Management Centre, CLIF Consortium, Barcelona, Spain.Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain Data Management Centre, CLIF Consortium, Barcelona, Spain.Hospital San Giovanni Battista Hospital, University of Torino, Italy.Liver Unit, Klinikum Munich, Lugwig Maximilian University of Munich, Germany.Intensive Care Unit, Hepatology Department, Kings College London, UK.Semeiotica Medica-Policlinico S. Orsola-Malpighi, University of Bologna, Italy.Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Fundación Renal Iñigo Alvarez de Toledo, (FRIAT), Madrid, Spain Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25311034

Citation

Angeli, Paolo, et al. "Acute Kidney Injury and Acute-on-chronic Liver Failure Classifications in Prognosis Assessment of Patients With Acute Decompensation of Cirrhosis." Gut, vol. 64, no. 10, 2015, pp. 1616-22.
Angeli P, Rodríguez E, Piano S, et al. Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis. Gut. 2015;64(10):1616-22.
Angeli, P., Rodríguez, E., Piano, S., Ariza, X., Morando, F., Solà, E., ... Ginès, P. (2015). Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis. Gut, 64(10), pp. 1616-22. doi:10.1136/gutjnl-2014-307526.
Angeli P, et al. Acute Kidney Injury and Acute-on-chronic Liver Failure Classifications in Prognosis Assessment of Patients With Acute Decompensation of Cirrhosis. Gut. 2015;64(10):1616-22. PubMed PMID: 25311034.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis. AU - Angeli,Paolo, AU - Rodríguez,Ezequiel, AU - Piano,Salvatore, AU - Ariza,Xavier, AU - Morando,Filippo, AU - Solà,Elsa, AU - Romano,Antonietta, AU - García,Elisabet, AU - Pavesi,Marco, AU - Risso,Alessandro, AU - Gerbes,Alexander, AU - Willars,Chris, AU - Bernardi,Mauro, AU - Arroyo,Vicente, AU - Ginès,Pere, AU - ,, Y1 - 2014/10/13/ PY - 2014/04/25/received PY - 2014/09/18/accepted PY - 2014/10/15/entrez PY - 2014/10/15/pubmed PY - 2015/12/15/medline KW - ACUTE LIVER FAILURE KW - CIRRHOSIS KW - LIVER SP - 1616 EP - 22 JF - Gut JO - Gut VL - 64 IS - 10 N2 - OBJECTIVE: Prognostic stratification of patients with cirrhosis is common clinical practice. This study compares the prognostic accuracy (28-day and 90-day transplant-free mortality) of the acute-on-chronic liver failure (ACLF) classification (no ACLF, ACLF grades 1, 2 and 3) with that of acute kidney injury (AKI) classification (no AKI, AKI stages 1, 2 and 3). DESIGN: The study was performed in 510 patients with an acute decompensation of cirrhosis previously included in the European Association for the Study of the Liver-Chronic Liver Failure consortium CANONIC study. ACLF was evaluated at enrollment and 48 h after enrollment, and AKI was evaluated at 48 h according to Acute Kidney Injury Network criteria. RESULTS: 240 patients (47.1%) met the criteria of ACLF at enrollment, while 98 patients (19.2%) developed AKI. The presence of ACLF and AKI was strongly associated with mortality. 28-day transplant-free mortality and 90-day transplant-free mortality of patients with ACLF (32% and 49.8%, respectively) were significantly higher with respect to those of patients without ACLF (6.2% and 16.4%, respectively; both p<0.001). Corresponding values in patients with and without AKI were 46% and 59%, and 12% and 25.6%, respectively (p<0.0001 for both). ACLF classification was more accurate than AKI classification in predicting 90-day mortality (area under the receiving operating characteristic curve=0.72 vs 0.62; p<0.0001) in the whole series of patients. Moreover, assessment of ACLF classification at 48 h had significantly better prognostic accuracy compared with that of both AKI classification and ACLF classification at enrollment. CONCLUSIONS: ACLF stratification is more accurate than AKI stratification in the prediction of short-term mortality in patients with acute decompensation of cirrhosis. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/25311034/Acute_kidney_injury_and_acute_on_chronic_liver_failure_classifications_in_prognosis_assessment_of_patients_with_acute_decompensation_of_cirrhosis_ L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&amp;pmid=25311034 DB - PRIME DP - Unbound Medicine ER -