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Evaluation of acute kidney injury and its response to terlipressin in patients with acute-on-chronic liver failure.
Liver Int 2016; 36(1):59-67LI

Abstract

BACKGROUND & AIMS

Patients with acute-on-chronic liver failure (ACLF) have high mortality. Cirrhotics with acute kidney injury (AKI) have poor outcome but relevance of AKI and response to terlipressin in ACLF is not known.

METHODS

Consecutive ACLF patients with AKI at admission were compared with those without AKI (controls) for mortality at day 7, month 1 and 3, presence of hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP) and acute variceal bleed (AVB). Patients were also compared based on severity of AKI (mild; S.cr 1.5-3 mg/dl and marked; S.cr >3 mg/dl). Response to terlipressin was also evaluated.

RESULTS

Of 241 ACLF patients, 55 (22.8%) had AKI at admission. Patients with AKI had higher mortality at day 7, 1 and 3 month and more often developed HE [54.1% vs. 30.6%; P = 0.001] and SBP [9.1% vs. 5.9%; P = 0.02]. Patients with marked AKI neither had higher mortality or complications in comparison to mild AKI. Presence of AKI [Odds ratio; OR, 2.4], S.bilirubin >20 mg/dl [OR, 3.1] and INR [OR, 2.9] were independent baseline predictors of mortality. Terlipressin was used in 28 of 55 patients with AKI who were volume non-responsive (hepatorenal syndrome, AKI-HRS). Ten (35.7%) of these showed response (S.Cr < 1.5 mg/dl) [median 4 days] and had lower mortality compared to terlipressin non-responders (10% vs. 50%, P = 0.05). There was no difference in terlipressin response in mild vs. marked AKI.

CONCLUSIONS

Almost one-fourth of the ACLF patients have AKI at admission and presence of AKI, but not its severity predicts complications and high mortality. Terlipressin effectively reverses AKI-HRS within a week in ~35% of ACLF patients resulting in improved survival.

Authors+Show Affiliations

Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India.Department of Biostatistics and Clinical Reserch, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India.Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India.Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India. Special Centre for Molecular Medicine, Jawaharlal Nehru University (JNU), New Delhi, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26081914

Citation

Jindal, Ankur, et al. "Evaluation of Acute Kidney Injury and Its Response to Terlipressin in Patients With Acute-on-chronic Liver Failure." Liver International : Official Journal of the International Association for the Study of the Liver, vol. 36, no. 1, 2016, pp. 59-67.
Jindal A, Bhadoria AS, Maiwall R, et al. Evaluation of acute kidney injury and its response to terlipressin in patients with acute-on-chronic liver failure. Liver Int. 2016;36(1):59-67.
Jindal, A., Bhadoria, A. S., Maiwall, R., & Sarin, S. K. (2016). Evaluation of acute kidney injury and its response to terlipressin in patients with acute-on-chronic liver failure. Liver International : Official Journal of the International Association for the Study of the Liver, 36(1), pp. 59-67. doi:10.1111/liv.12895.
Jindal A, et al. Evaluation of Acute Kidney Injury and Its Response to Terlipressin in Patients With Acute-on-chronic Liver Failure. Liver Int. 2016;36(1):59-67. PubMed PMID: 26081914.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of acute kidney injury and its response to terlipressin in patients with acute-on-chronic liver failure. AU - Jindal,Ankur, AU - Bhadoria,Ajeet S, AU - Maiwall,Rakhi, AU - Sarin,Shiv K, Y1 - 2015/09/18/ PY - 2015/03/31/received PY - 2015/06/02/accepted PY - 2015/6/18/entrez PY - 2015/6/18/pubmed PY - 2016/11/1/medline KW - cirrhosis KW - liver failure KW - renal dysfunction SP - 59 EP - 67 JF - Liver international : official journal of the International Association for the Study of the Liver JO - Liver Int. VL - 36 IS - 1 N2 - BACKGROUND & AIMS: Patients with acute-on-chronic liver failure (ACLF) have high mortality. Cirrhotics with acute kidney injury (AKI) have poor outcome but relevance of AKI and response to terlipressin in ACLF is not known. METHODS: Consecutive ACLF patients with AKI at admission were compared with those without AKI (controls) for mortality at day 7, month 1 and 3, presence of hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP) and acute variceal bleed (AVB). Patients were also compared based on severity of AKI (mild; S.cr 1.5-3 mg/dl and marked; S.cr >3 mg/dl). Response to terlipressin was also evaluated. RESULTS: Of 241 ACLF patients, 55 (22.8%) had AKI at admission. Patients with AKI had higher mortality at day 7, 1 and 3 month and more often developed HE [54.1% vs. 30.6%; P = 0.001] and SBP [9.1% vs. 5.9%; P = 0.02]. Patients with marked AKI neither had higher mortality or complications in comparison to mild AKI. Presence of AKI [Odds ratio; OR, 2.4], S.bilirubin >20 mg/dl [OR, 3.1] and INR [OR, 2.9] were independent baseline predictors of mortality. Terlipressin was used in 28 of 55 patients with AKI who were volume non-responsive (hepatorenal syndrome, AKI-HRS). Ten (35.7%) of these showed response (S.Cr < 1.5 mg/dl) [median 4 days] and had lower mortality compared to terlipressin non-responders (10% vs. 50%, P = 0.05). There was no difference in terlipressin response in mild vs. marked AKI. CONCLUSIONS: Almost one-fourth of the ACLF patients have AKI at admission and presence of AKI, but not its severity predicts complications and high mortality. Terlipressin effectively reverses AKI-HRS within a week in ~35% of ACLF patients resulting in improved survival. SN - 1478-3231 UR - https://www.unboundmedicine.com/medline/citation/26081914/Evaluation_of_acute_kidney_injury_and_its_response_to_terlipressin_in_patients_with_acute_on_chronic_liver_failure_ L2 - https://doi.org/10.1111/liv.12895 DB - PRIME DP - Unbound Medicine ER -