Observational Study
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World J Hepatol. Mar 27, 2022; 14(3): 592-601
Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.592
Predictors of mortality at 28-days in infection associated acute kidney injury in cirrhosis
Tarana Gupta, Naveen Ranga, Sandeep Kumar Goyal
Tarana Gupta, Naveen Ranga, Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
Sandeep Kumar Goyal, Independent Researcher, Kangra 176056, Himachal Pradesh, India
Author contributions: Gupta T was the guarantor and designed the study; Ranga N was involved in acquisition of data and drafted the initial manuscript; Goyal SK performed statistical analysis and interpretation of data; Gupta T revised the manuscript critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the institutional ethics committee at Pt. BD Sharma Institute of Medical Sciences, Rohtak (India).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tarana Gupta, MBBS, MD, Doctor, Professor, Department of Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Medical Mor, Rohtak 124001, Haryana, India. taranagupta@gmail.com
Received: May 18, 2021
Peer-review started: May 18, 2021
First decision: June 22, 2021
Revised: July 4, 2021
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: March 27, 2022
Processing time: 309 Days and 22.4 Hours
ARTICLE HIGHLIGHTS
Research background

Acute kidney injury (AKI) in cirrhosis has dismal outcomes. Recent data suggests infections being most common insult for acute decompensation of cirrhosis. Infections lead to acute deterioration of already compromised hemodynamics in cirrhosis.

Research motivation

Infections in cirrhosis is a precursor towards multi-organ dysfunction. Kidney failure is one of the early manifestation in cirrhosis which has a potential for reversibility. Identifying high risk of mortality in patients with AKI in cirrhosis may warrant early institution of treatment, especially in presence of infection. This may help to develop new protocols to salvage kidney in presence of infections in cirrhosis.

Research objectives

To compare infection and non-infection AKI in cirrhosis, and to determine predictors of mortality at 28-d in patients with infection associated AKI.

Research methods

It was a prospective, observational study conducted at a tertiary care hospital for a period of 1 year. After written, informed consent total 119 patients with AKI in cirrhosis were included into the study. AKI was defined as per International Club of Ascites-AKI 2015 criteria. Patients were divided into infection and non-infection AKI groups. Non-infection AKI included patients with pre-renal and diuretic induced AKI. Infection and non-infection AKI groups were compared for clinical and laboratory data. In infection AKI group logistic regression analysis was performed to determine 28-d predictors of mortality.

Research results

There were 119 patients of cirrhosis with AKI. Alcohol (n = 104) was most common etiology of cirrhosis. The infection AKI group had 67 (56%) patients and non-infection AKI had 52 (44%) patients which included pre-renal AKI in 36 (30%) and diuretic-induced AKI in 16 (14%). Infection AKI patients had higher progression of AKI (19/67 vs 2/52; P = 0.01) and 28-d mortality (38/67 vs 4/5; P ≤ 0.01) as compared to non-infection AKI patients. On subgroup analysis of Infection AKI group, on multivariate analysis, serum bilirubin as well as presence of HE were independent predictors of 28-d mortality. There was no significant difference of mortality at 90-d between two groups.

Research conclusions

This study says that AKI in cirrhosis with infection has high short term mortality. High bilirubin and presence of hepatic encephalopathy predicts high 28-d mortality in infection associated AKI. Probably AKI in patients with cirrhosis is multifactorial with sepsis, volume depletion, bilirubin as important factors.

Research perspectives

High bilirubin levels can contribute to nephropathy as well as encephalopathy. Still, we do not have effective therapies for high bilirubin values. Future research should focus on drugs to lower bilirubin levels. And probably more data is needed on infections in cirrhosis.