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. 2024 Mar 1;30(3):244-253.
doi: 10.1097/LVT.0000000000000241. Epub 2023 Aug 9.

Prognostic significance of acute kidney injury stage 1B in hospitalized patients with cirrhosis: A US nationwide study

Kavish R Patidar  1 , Giuseppe Cullaro  2 , Mobasshir A Naved  3 , Shaowli Kabir  4 , Ananth Grama  3 , Eric S Orman  5 , Salvatore Piano  6 , Andrew S Allegretti  7
Affiliations

Prognostic significance of acute kidney injury stage 1B in hospitalized patients with cirrhosis: A US nationwide study

Kavish R Patidar et al. Liver Transpl. .

Abstract

Understanding the prognostic significance of acute kidney injury (AKI) stage 1B [serum creatinine (sCr) ≥1.5 mg/dL] compared with stage 1A (sCr < 1.5 mg/dL) in a US population is important as it can impact initial management decisions for AKI in hospitalized cirrhosis patients. Therefore, we aimed to define outcomes associated with stage 1B in a nationwide US cohort of hospitalized cirrhosis patients with AKI. Hospitalized cirrhosis patients with AKI in the Cerner-Health-Facts database from January 2009 to September 2017 (n = 6250) were assessed for AKI stage 1 (≥1.5-2-fold increase in sCr from baseline) and were followed for 90 days for outcomes. The primary outcome was 90-day mortality; secondary outcomes were in-hospital AKI progression and AKI recovery. Competing-risk multivariable analysis was performed to determine the independent association between stage 1B, 90-day mortality (liver transplant as a competing risk), and AKI recovery (death/liver transplant as a competing risk). Multivariable logistic regression analysis was performed to determine the independent association between stage 1B and AKI progression. In all, 4654 patients with stage 1 were analyzed: 1A (44.3%) and 1B (55.7%). Stage 1B patients had a significantly higher cumulative incidence of 90-day mortality compared with stage 1A patients, 27.2% versus 19.7% ( p < 0.001). In multivariable competing-risk analysis, patients with stage 1B (vs. 1A) had a higher risk for mortality at 90 days [sHR 1.52 (95% CI 1.20-1.92), p = 0.001] and decreased probability for AKI recovery [sHR 0.76 (95% CI 0.69-0.83), p < 0.001]. Furthermore, in multivariable logistic regression analysis, AKI stage 1B (vs. 1A) was independently associated with AKI progression, OR 1.42 (95% CI 1.14-1.72) ( p < 0.001). AKI stage 1B patients have a significantly higher risk for 90-day mortality, AKI progression, and reduced probability of AKI recovery compared with AKI stage 1A patients. These results could guide initial management decisions for AKI in hospitalized patients with cirrhosis.

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Conflict of interest statement

CONFLICTS OF INTEREST

Giuseppe Cullaro consults for Ocelot Bio and Retro. He owns stock in Eli Lilly and Novo Nordisk. Eric S. Orman advises BioVie. Salvatore Piano consults for Plasma Protein Therapeutics and Resolution Therapeutics. He advises Mallinckrodt. He is on the speakers’ bureau for Grifols. Andrew S. Allegretti consults for Mallinckrodt and Ocelot Bio. The remaining authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Comparison of cumulative incidence of 90-day mortality between acute kidney injury stages 1A and 1B.
See this image and copyright information in PMC

Comment in

References

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