Progression of Stage 2 and 3 Acute Kidney Injury in Patients With Decompensated Cirrhosis and Ascites.

Autor:	Wong F; University of Toronto, Department of Medicine, Division of Gastroenterology & Hepatology, Toronto, Ontario, Canada. Electronic address: florence.wong@utoronto.ca., Reddy KR; University of Pennsylvania, Department of Medicine, Division of Gastroenterology & Hepatology, Philadelphia, Pennsylvania., Tandon P; University of Alberta, Department of Medicine, Division of Gastroenterology, Edmonton, Alberta, Canada., O'Leary JG; Dallas VA Medical Center, Department of Internal Medicine, Division of Gastroenterology, Dallas, Texas; Baylor University Medical Center, Dallas, Texas., Garcia-Tsao G; Yale University, Section of Digestive Diseases, Departemtn of Medicine, New Haven, Connecticut., Vargas HE; Mayo Clinic, Division of Gastroenterology and Hepatology and Transplantation Center, Scottsdale, Arizona., Lai JC; University of California San Francisco, Department of Medicine, Division of Gastroenterology/ Hepatology, San Francisco, California., Biggins SW; University of Washington Medical Center, Department of Medicine, Division of Gastroenterology, Seattle, Washington., Maliakkal B; University of Tennessee, Department of Medicine, Division of Transplant Hepatology, Memphis, Tennessee., Fallon M; University of Arizona College of Medicine, Department of Medicine, Division of Transplant Hepatology, Phoenix, Arizona., Subramanian R; Emory University, Department of Medicine, Division of Digestive Diseases, Atlanta, Georgia., Thuluvath P; Mercy Medical Center, Division of Gastroenterology, University of Maryland School of Medicine, Baltimore, Maryland., Kamath PS; Mayo Clinic College of Medicine and Science, Division of Gastroenterology and Hepatology, Rochester, Minnesota., Thacker L; Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia., Bajaj JS; Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Health Care System, Richmond, Virginia.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2021 Aug; Vol. 19 (8), pp. 1661-1669.e2. Date of Electronic Publication: 2020 Aug 13.
DOI:	10.1016/j.cgh.2020.08.025
Abstrakt:	Background & Aims: Progression of stages 2 and 3 acute kidney injury (AKI) in cirrhosis has not been characterized adequately. Patients with higher stages of AKI are believed to have worse outcomes. We assessed outcomes and factors associated with stages 2 and 3 AKI in patients with cirrhosis in the North American Consortium for the Study of End-stage Liver Disease cohort. Methods: We collected data from 2297 hospitalized patients with cirrhosis and ascites from December 2011 through February 2017. Our final analysis included 760 patients who developed AKI per the International Ascites Club 2015 definition (419 with maximum stage 1 and 341 with maximum stage 2 or 3; 63% male; mean age, 58 y). We compared demographic features, laboratory values, AKI treatment response, and survival between patients with maximum stage 1 vs patients with stage 2 or 3 AKI. Results: Patients with stage 2 or 3 AKI had higher Model for End-Stage Liver Disease scores (25.9 ± 7.3) than patients with stage 1 AKI (21.9 ± 7.5) (P < .0001). More patients fulfilled systemic inflammatory response syndrome criteria on admission, and more developed a second nosocomial infection (P < .05 for both comparisons). More patients with stage 2 or 3 AKI also had progression of AKI and required dialysis and admission into intensive care units when compared to stage 1 AKI patients (P < .0001 for both). A lower proportion of patients with stage 2 or 3 AKI survived their hospital stay (80% vs 99% with stage 1 AKI; P < .0001), or survived for 30 days without a liver transplant (56% vs 81%; P < .0001). The development of stage 2 or 3 AKI was associated with a higher Model for End-Stage Liver Disease score at the time of admission (P < .0001), presence of systemic inflammatory response on admission (P = .039), and second infection (P < .0001). Conclusions: Based on an analysis of data from the North American Consortium for the Study of End-stage Liver Disease cohort, we found that patients with cirrhosis and more advanced liver disease, as well as a second infection, are more likely to develop stages 2 or 3 AKI, with a progressive course associated with decreased 30-day transplant-free survival. Prevention of AKI progression in patients with cirrhosis and stage 2 or 3 AKI might improve their outcomes. (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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