Amit Hanmant Shejal1, Thazhath Mavali Ramachandran2, Sunil Kumar N3, Sandeep Viswanathan Nair4
BACKGROUND
Acute Kidney Injury (AKI) is a common complication in patients with cirrhosis leading to high mortality. Creatinine-based criteria for defining AKI are validated in general hospitalised patients, but their application to cirrhotic patients is less certain. This study was undertaken to evaluate current definition of AKI by International Club of Ascites (ICA) and assess clinical course of hospitalised cirrhosis patients with AKI and to study the impact of AKI on mortality.
MATERIALS AND METHODS
We prospectively studied patients with AKI and cirrhosis for a period of 1 year and assessed the association between AKI severity and progression with complications, including death.
RESULTS
48 cirrhotic patients with AKI were enrolled in the study period. Mean age of patients was 56.81 ± 9.78 years. The aetiology of cirrhosis included alcohol (52.1%), HBV (2.2%), HCV (4.2%), NASH (27.1%) and cryptogenic (14.6%). 13 patients (27.1%) had mortality while 35 patients (72.9%) survived. 39 patients (81.25%) had AKI at admission while 9 patients (18.75%) developed later after admission. Patients achieved a peak severity of AKI stage 1, 10.41%; stage 2, 60.41%; and stage 3, 37.5%. The incidence of mortality, increased with severity of AKI in stepwise manner with peak AKI stage 1 has no mortality; stage 2 has 4 (30.76%); stage 3, 9 (69.23%). SIRS was present in 17 patients (35.4%) and was significantly associated with mortality.
CONCLUSION
AKI, as defined by new ICA criteria, in patients with cirrhosis is associated with mortality in a stage-dependent fashion. Early intervention and preventing progression by timely and specific treatment may improve outcomes.
