Natural history, spectrum and outcome of stage 3 AKI in patients with acute‐on‐chronic liver failure

Liver International - Tập 42 Số 12 - Trang 2800-2814 - 2022
Rakhi Maiwall1, Archana Rastogi2, Samba Siva Rao Pasupuleti3, Ashini Hidam4, Mansi Singh4, Sonia Kadyan4, Priyanka Jain5, Guresh Kumar5, Shiv Kumar Sarin1
1Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
2Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
3Department of Statistics, Mizoram University (A Central University), Pachhunga University College Campus, Aizawl, India
4Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
5Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India

Tóm tắt

AbstractBackground and AimThere is limited data on natural course and interventions in stage‐3 acute kidney injury (AKI‐3) in patients with acute‐on‐chronic liver failure (ACLF). We studied the factors of AKI‐3 reversal and outcomes of dialysis in ACLF patients.MethodsConsecutive patients with ACLF were prospectively enrolled (n = 1022) and variables determining AKI and its outcomes were analysed.ResultsAt 1 month, 337 (33%) patients had AKI‐3, of which, 131 had AKI‐3 at enrolment and 206 developed AKI‐3 during hospital stay. Of patients with AKI‐3 at enrolment, 18% showed terlipressin response, 21% had AKI resolution and 59% required dialysis. High MELD (≥35) (model 1), serum bilirubin (≥23 mg/dL) (model 2) and AARC score (≥11) (model 3) were independent risk factors for dialysis. Dialysis was associated with worse survival in all AKI patients but improved outcomes in patients with AKI‐3 (p = .022, HR 0.69 [0.50–0.95]). Post‐mortem kidney biopsies (n = 61) revealed cholemic nephropathy (CN) in 54%, acute tubular necrosis (ATN) in 31%, and a combination (CN and ATN) in 15%. Serum bilirubin was significantly higher in patients with CN, CN and ATN compared with ATN respectively ([30.8 ± 12.2] vs. [26.7 ± 12.0] vs. [18.5 ± 9.8]; p = .002).ConclusionAKI‐3 rapidly increases from 13% to 33% within 30 days in ACLF patients. Histopathological data suggested cholemic nephropathy as the predominant cause which correlated with high bilirubin levels. AKI‐3 resolves in only one in five patients. Patients with AARC grade 3 and MELD >35 demand need for early dialysis in AKI‐3 for improved outcomes.

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Liver International

Tập 42 Số 12

2800-2814

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