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. 2022 Aug;6(8):2121-2131.
doi: 10.1002/hep4.1963. Epub 2022 May 10.

Patterns of kidney dysfunction in acute-on-chronic liver failure: Relationship with kidney and patients' outcome

Laura Napoleone  1   2   3 , Cristina Solé  1   2   3 , Adrià Juanola  1   2   3 , Ann T Ma  1   2   3 , Marta Carol  1   2   3   4 , Martina Pérez-Guasch  1   2   3   4 , Ana-Belén Rubio  1   2   3 , Marta Cervera  1   2   3   4 , Emma Avitabile  1   2   3 , Octavi Bassegoda  1   2   3 , Jordi Gratacós-Ginès  1   2   3 , Manuel Morales-Ruiz  2   3   4   5 , Núria Fabrellas  1   2   3   4 , Isabel Graupera  1   2   3   4 , Elisa Pose  1   2   3 , Gonzalo Crespo  1   2   3 , Elsa Solà  1   2   3 , Pere Ginès  1   2   3   4
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Patterns of kidney dysfunction in acute-on-chronic liver failure: Relationship with kidney and patients' outcome

Laura Napoleone et al. Hepatol Commun. 2022 Aug.

Abstract

Impairment of kidney function is common in acute-on-chronic liver failure (ACLF). Patterns of kidney dysfunction and their impact on kidney and patient outcomes are ill-defined. Aims of the current study were to investigate patterns of kidney dysfunction and their impact on kidney and patient outcomes in patients with acute decompensation (AD) of cirrhosis, with or without ACLF. This prospective study includes 639 admissions for AD (232 with ACLF; 407 without) in 518 patients. Data were collected at admission and during hospitalization, and patients were followed up for 3 months. Urine samples were analyzed for kidney biomarkers. Most patients with ACLF (92%) had associated acute kidney injury (AKI), in most cases without previous chronic kidney disease (CKD), whereas some had AKI-on-CKD (70% and 22%, respectively). Prevalence of AKI in patients without ACLF was 35% (p < 0.001 vs. ACLF). Frequency of CKD alone was low and similar in both groups (4% and 3%, respectively); only a few patients with ACLF (4%) had no kidney dysfunction. AKI in ACLF was associated with poor kidney and patient outcomes compared with no ACLF (AKI resolution: 54% vs. 89%; 3-month survival: 51% vs. 86%, respectively; p < 0.001 for both). Independent predictive factors of 3-month survival were Model for End-Stage Liver Disease-Sodium score, ACLF status, and urine neutrophil gelatinase-associated lipocalin (NGAL). AKI is almost universal in patients with ACLF, sometimes associated with CKD, whereas CKD alone is uncommon. Prognosis of AKI depends on ACLF status. AKI without ACLF has good prognosis. Best predictors of 3-month survival are MELD-Na, ACLF status, and urine NGAL.

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Conflict of interest statement

P.G. received research funding from Mallinckrodt, Grifols, and Gilead. He participated on advisory boards for Novartis, Gilead, and Martin Pharmaceuticals. The other authors have no conflicts of interest to report.

Figures

FIGURE 1
FIGURE 1
Time course of urinary neutrophil gelatinase–associated lipocalin (NGAL) levels in patients with acute kidney injury (AKI) categorized according to the presence or absence of associated acute‐on‐chronic liver failure (ACLF). The number of patients at risk at each time point is shown at the bottom. Levels of significance: p < 0.001 at day 1 and 3, p = 0.04 at day 7, p = 0.1 at day 14
FIGURE 2
FIGURE 2
Survival probability curves of patients categorized according to the presence of AKI with and without associated ACLF. Shown are 3‐month survival probability curves of patients classified into four groups: (1) patients without AKI and without ACLF (n = 258); (2) patients with AKI without ACLF (n = 92); (3) patients without AKI but with ACLF (n = 16); and (4) patients with both AKI and ACLF (n = 152). Levels of significance: p < 0.001 with respect to all groups
FIGURE 3
FIGURE 3
Survival probability curves of patients with ACLF categorized according to the stage of AKI. Shown are 3‐month survival probability curves of patients with ACLF classified into four groups: (1) patients with AKI 1A (n = 20); (2) patients with AKI 1B (n = 65); (3) patients with AKI 2 (n = 41); and (4) patients with AKI 3 (n = 26). Levels of significance: p = 0.9 with respect to all groups
FIGURE 4
FIGURE 4
Plots of the relationship between Model for End‐Stage Liver Disease–Sodium (MELD‐Na) score and 90‐day transplant‐free mortality in patients with AKI categorized according to presence (discontinuous line) or absence (continuous line) of ACLF
See this image and copyright information in PMC

References

    1. Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2021;398:1359–76. - PubMed
    1. Angeli P, Gines P, Wong F, Bernardi M, Boyer TD, Gerbes A, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. J Hepatol. 2015;62:968–74. - PubMed
    1. Ginès P, Solà E, Angeli P, Wong F, Nadim MK, Kamath PS. Hepatorenal syndrome. Nat Rev Dis Primers. 2018;4:23. - PubMed
    1. Fagundes C, Barreto R, Guevara M, Garcia E, Solà E, Rodríguez E, et al. A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis. J Hepatol. 2013;59:474–81. - PubMed
    1. Piano S, Rosi S, Maresio G, Fasolato S, Cavallin M, Romano A, et al. Evaluation of the acute kidney network criteria in hospitalized patients with cirrhosis and ascites. J Hepatol. 2013;59:482–9. - PubMed

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