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AKI persistence at 48 h predicts mortality in patients with acute on chronic liver failure.
Hepatol Int 2017; 11(6):529-539HI

Abstract

BACKGROUND AND AIM

Management of acute kidney injury (AKI) in cirrhotics has undergone a paradigm change. We evaluated the impact of AKI persistence at 48 h on outcome in patients with acute on chronic liver failure (ACLF).

METHODS

Consecutive patients with ACLF (n = 373) were prospectively followed. AKI was defined as increase in serum creatinine of 0.3 mg/dl or 1.5- to 2-fold from baseline. Persistent AKI was defined as nonresponsive AKI at 48 h with respect to admission serum creatinine.

RESULTS

AKI at admission was present in 177 (47.5 %) patients. At 48 h, 73 % patients had persistent AKI and 27 % had responsive AKI. High Model for End-Stage Liver Disease (MELD) (≥26) [p, odds ratio (OR), 95 % confidence interval (CI)] [<0.001, 3.65 (2.1-3.67)], systemic inflammatory response syndrome (SIRS) [0.03, 1.6 (1.02-21.6)], and age (≥42 years) [0.03, 1.84 (1.19-2.85)] were significant predictors of AKI persistence. Persistent AKI was associated with significantly higher in-hospital mortality [p < 0.001, hazard ratio (HR) 1.7, 95 % CI 1.32-2.27]. We further found a lower cutoff for serum creatinine of 1.14 mg/dl at 48 h with better sensitivity of 61 %, specificity of 61 %, and likelihood ratio (LR+) of 1.6, correctly classifying 61 %, as against the conventional cutoff of 1.5 mg/dl with sensitivity of 37 %, specificity of 57 %, and LR+ of 3.3, correctly classifying 56 %. This new cutoff also predicted mortality with higher odds (OR 2.4, 95 % CI 1.3-4.8) as compared with the conventional cutoff (OR 2.1, 95 % CI 1.1-4.1).

CONCLUSION

AKI persistence at 48 h predicts mortality better than serum creatinine of 1.5 mg/dl in patients with ACLF. Serum creatinine value of 1.14 mg/dl and smaller increases in its value should be considered for risk stratification of patients with ACLF for interventional strategies.

Authors+Show Affiliations

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India.Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28983839

Citation

Maiwall, Rakhi, et al. "AKI Persistence at 48 h Predicts Mortality in Patients With Acute On Chronic Liver Failure." Hepatology International, vol. 11, no. 6, 2017, pp. 529-539.
Maiwall R, Kumar G, Bharadwaj A, et al. AKI persistence at 48 h predicts mortality in patients with acute on chronic liver failure. Hepatol Int. 2017;11(6):529-539.
Maiwall, R., Kumar, G., Bharadwaj, A., Jamwal, K., Bhadoria, A. S., Jain, P., & Sarin, S. K. (2017). AKI persistence at 48 h predicts mortality in patients with acute on chronic liver failure. Hepatology International, 11(6), pp. 529-539. doi:10.1007/s12072-017-9822-1.
Maiwall R, et al. AKI Persistence at 48 h Predicts Mortality in Patients With Acute On Chronic Liver Failure. Hepatol Int. 2017;11(6):529-539. PubMed PMID: 28983839.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - AKI persistence at 48 h predicts mortality in patients with acute on chronic liver failure. AU - Maiwall,Rakhi, AU - Kumar,Guresh, AU - Bharadwaj,Ankit, AU - Jamwal,Kapil, AU - Bhadoria,Ajeet Singh, AU - Jain,Priyanka, AU - Sarin,Shiv Kumar, Y1 - 2017/10/05/ PY - 2017/04/29/received PY - 2017/09/06/accepted PY - 2017/10/7/pubmed PY - 2018/11/8/medline PY - 2017/10/7/entrez KW - ACLF KW - AKI KW - Persistence of AKI SP - 529 EP - 539 JF - Hepatology international JO - Hepatol Int VL - 11 IS - 6 N2 - BACKGROUND AND AIM: Management of acute kidney injury (AKI) in cirrhotics has undergone a paradigm change. We evaluated the impact of AKI persistence at 48 h on outcome in patients with acute on chronic liver failure (ACLF). METHODS: Consecutive patients with ACLF (n = 373) were prospectively followed. AKI was defined as increase in serum creatinine of 0.3 mg/dl or 1.5- to 2-fold from baseline. Persistent AKI was defined as nonresponsive AKI at 48 h with respect to admission serum creatinine. RESULTS: AKI at admission was present in 177 (47.5 %) patients. At 48 h, 73 % patients had persistent AKI and 27 % had responsive AKI. High Model for End-Stage Liver Disease (MELD) (≥26) [p, odds ratio (OR), 95 % confidence interval (CI)] [<0.001, 3.65 (2.1-3.67)], systemic inflammatory response syndrome (SIRS) [0.03, 1.6 (1.02-21.6)], and age (≥42 years) [0.03, 1.84 (1.19-2.85)] were significant predictors of AKI persistence. Persistent AKI was associated with significantly higher in-hospital mortality [p < 0.001, hazard ratio (HR) 1.7, 95 % CI 1.32-2.27]. We further found a lower cutoff for serum creatinine of 1.14 mg/dl at 48 h with better sensitivity of 61 %, specificity of 61 %, and likelihood ratio (LR+) of 1.6, correctly classifying 61 %, as against the conventional cutoff of 1.5 mg/dl with sensitivity of 37 %, specificity of 57 %, and LR+ of 3.3, correctly classifying 56 %. This new cutoff also predicted mortality with higher odds (OR 2.4, 95 % CI 1.3-4.8) as compared with the conventional cutoff (OR 2.1, 95 % CI 1.1-4.1). CONCLUSION: AKI persistence at 48 h predicts mortality better than serum creatinine of 1.5 mg/dl in patients with ACLF. Serum creatinine value of 1.14 mg/dl and smaller increases in its value should be considered for risk stratification of patients with ACLF for interventional strategies. SN - 1936-0541 UR - https://www.unboundmedicine.com/medline/citation/28983839/AKI_persistence_at_48 h_predicts_mortality_in_patients_with_acute_on_chronic_liver_failure_ L2 - https://dx.doi.org/10.1007/s12072-017-9822-1 DB - PRIME DP - Unbound Medicine ER -