New Consensus Definition of Acute Kidney Injury Accurately Predicts 30-Day Mortality in Patients With Cirrhosis and Infection

作者：Wong Florence^*; O' Leary Jacqueline G; Reddy K Rajender; Patton Heather; Kamath Patrick S; Fallon Michael B; Garcia Tsao Guadalupe; Subramanian Ram M; Malik Raza; Maliakkal Benedict; Thacker Leroy R; Bajaj Jasmohan S

来源：Gastroenterology, 2013, 145(6): 1280-+.

DOI：10.1053/j.gastro.2013.08.051

• Bacterial Infection
• Liver Fibrosis
• Hepatorenal Syndrome
• MELD

BACKGROUND %26 AIMS: Participants at a consensus conference proposed defining cirrhosis-associated acute kidney injury (AKI) based on a %26gt;50% increase in serum creatinine level from the stable baseline value in %26lt;6 months or an increase of %26gt;= 0.3 mg/dL in %26lt;48 hours. We performed a prospective study to evaluate the ability of these criteria to predict mortality within 30 days of hospitalization among patients with cirrhosis and infection. METHODS: We followed up 337 patients with cirrhosis who were admitted to the hospital with an infection or developed an infection during hospitalization (56% men; 56 +/- 10 years of age; Model for End-Stage Liver Disease [MELD] score, 20 +/- 8) at 12 centers in North America. We compared data on 30-day mortality, length of stay in the hospital, and organ failure between patients with and without AKI. RESULTS: In total, based on the consensus criteria, 166 patients (49%) developed AKI during hospitalization. Patients who developed AKI were admitted with higher Child-Pugh scores than those who did not develop AKI (11.0 +/- 2.1 vs 9.6 +/- 2.1; P %26lt; .0001) as well as higher MELD scores (23 +/- 8 vs 17 +/- 7; P %26lt; .0001) and lower mean arterial pressure (81 +/- 16 vs 85 +/- 15 mm Hg; P %26lt; .01). Higher percentages of patients with AKI died within 30 days of hospitalization (34% vs 7%), were transferred to the intensive care unit (46% vs 20%), required ventilation (27% vs 6%), or went into shock (31% vs 8%); patients with AKI also had longer stays in the hospital (17.8 +/- 19.8 vs 13.3 +/- 31.8 days) (all P %26lt; .001). Of the AKI episodes, 56% were transient, 28% were persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%) compared with partial (40%) or complete recovery (15%) or those who did not develop AKI (7%; P %26lt;.0001). CONCLUSIONS: Among patients with cirrhosis, 30-day mortality is 10-fold higher among those with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure.

• 出版日期2013-12