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Acute kidney injury network criteria as a prognostic factor in cirrhotic patients with spontaneous bacterial peritonitis
The Egyptian Journal of Internal Medicine volume 30, pages 264–270 (2018)
Abstract
Background and aim
One of the most common complications of spontaneous bacterial peritonitis (SBP) is renal injury. The aim of the study was to detect the frequency of AKI as a problem in end stage liver disease patients with SBP, evaluate the role of acute kidney injury network criteria (AKIN) as a prognostic factor for kidney insult in cirrhotic patients complicated by SBP and lastly.
Settings and design
A single center, observational, prospective study.
Patients and methods
The study was conducted on 150 cirrhotic patients complicated by SBP who were admitted in hepatology unit, Mansoura Specialized Medical Hospital, Mansoura University. After that, all patients were followed up for three months duration.
Statistical analysis used
Data analysis was performed using SPSS version 16.0 (SPSS, Inc, USA). Chi-square test (crosstabs) was used to compare the distribution of different clinical finding according to AKI stage.
Results
The obtained results were showed a significant change in the number of patients among the three groups at the end of the study versus at admission indicating progressive deterioration of kidney functions. Moreover, the mortality was high (70.42%), most of them were AKIN stage 2 and 3. There was a significant increase of hospital acquired complication especially (hepatic encephalopathy, ICU admission) more commonly in advanced AKIN stages (stage 3).
Conclusion
AKI, as defined by AKIN diagnostic criteria, is associated with a high mortality rate in cirrhotic patients presented with SBP, especially patients with advanced liver disease (Child B and C, high MELD score) in a stage-dependent pattern.
References
Ahmed O, Rodrigues DM, Brahmania M, Patel K. Su1570-low incidence of spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhosis undergoing paracentesis: a systematic review and meta-analysis. Gastroenterology 2018; 154:S-1181.
Gerbes AL. Liver cirrhosis and kidney. Dig Dis 2016; 34:387–390.
Russ KB, Stevens TM, Singal AK. Acute kidney injury in patients with cirrhosis. J Clin Transl Hepatol 2015; 3:195–204.
Gameiro J, Fonseca JA, Dias JM, Melo MJ, Jorge S, Velosa J, et al. Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers. Int J Nephrol Renovasc Dis 2018; 11:149–154.
Wong F. Acute kidney injury in liver cirrhosis: new definition and application. Clin Mol Hepatol 2016; 22:415–422.
Belcher JM, Garcia-Tsao G, Sanyal AJ, Bhogal H, Lim JK, Ansari N, et al. Association of AKI with mortality and complications in hospitalized patients with cirrhosis. Hepatology 2013; 57:753–762.
Salgado G, Landa M, Masevicius D, Gianassi S, San-Roman JE, Silva L, et al. Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study. Med Intensiva 2014; 38:271–277.
Lee DH, Lee JH, Jung YJ, Gim J, Kim W, Kim BG, et al. Validation of a modified Child-Turcotte-Pugh classification system utilizing insulin-like growth factor-1 for patients with hepatocellular carcinoma in an HBV endemic area. PloS One 2017; 12:e0170394.
Barasch J, Zager R, Bonventre JV. Acute kidney injury: a problem of definition. Lancet 2017; 389:779–781.
Maher MM, Yosef TM, Ibrahim WA, Hussein MM, Mohsen M, Khayal AS, et al. Significance of von Willebrand factor in compensated and decompensated cirrhosis. GARJMMS 2017; 6:302–309.
Protty MB, Haboubi HN, Yeoman AD. Changes in the Model for End-Stage Liver Disease (MELD) scores on day 7 predict mortality in acute on chronic liver disease: the delta-MELD project. J Hepatol 2017; 66: S387.
Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology 2007; 45:797–805.
Wiest R, Krag A, Gerbes A. Spontaneous bacterial peritonitis: recent guidelines and beyond. Gut 2012; 61:297–310.
Tandon P, Garcia-Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol 2011; 9:260–265.
Fang JT, Tsai MH, Tian YC, Jenq CC, Lin CY, Chen YC, et al. Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure. Nephrol Dial Transplant 2008; 23:1961–1969.
Fuchs M, Sanyal AJ. Sepsis and cholestasis. Clin Liver Dis 2008; 12:151–172.
De Carvalho JR, Villela-Nogueira CA, Luiz RR, Guzzo PL, Da Silva Rosa JM, Rocha E, et al. Acute kidney injury network criteria as a predictor of hospital mortality in cirrhotic patients with ascites. J Clin Gastroenterol 2012; 46:e21–e26.
Piano S, Rosi S, Maresio G, Fasolato S, Cavallin M, Romano A, et al. Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites. J Hepatol 2013; 59:482–489.
Scott RA, Austin AS, Kolhe NV, McIntyre CW, Selby NM. Acute kidney injury is independently associated with death in patients with cirrhosis. Frontline Gastroenterol 2013; 4:191–197.
Lai JC, Covinsky KE, Dodge JL, Boscardin WJ, Segev DL, Roberts JP, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology 2017; 66:564–574.
Jenq CC, Tsai MH, Tian YC, Lin CY, Yang C, Liu NJ, et al. RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients. Intensive Care Med 2007; 33:1921–1930.
Melcarne L, Sopeña J, MartÃnez-Cerezo FJ, Vergara M, Miquel M, Sanchez-Delgado J, et al. Prognostic factors of liver cirrhosis mortality after a first episode of spontaneous bacterial peritonitis. A multicenter study. Rev Esp Enferm Dig 2018; 110:94–101.
Wong F, O’Leary JG, Reddy KR, Garcia-Tsao G, Fallon MB, Biggins SW, et al. Acute kidney injury in cirrhosis: baseline serum creatinine predicts patient outcomes. Am J Gastroenterol 2017; 112:1103–1110.
Huelin P, Piano S, Solà E, Stanco M, Solé C, Moreira R, et al. Validation of a staging system for acute kidney injury in patients with cirrhosis and association with acute-on-chronic liver failure. Clin Gastroenterol Hepatol 2017; 15:438–445.
de Araujo A, Lvares-da-Silva MR. Akin criteria as a predictor of mortality in cirrhotic patients after spontaneous bacterial peritonitis. Ann Hepatol 2014; 13:3.
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El-Gamal, S., El-Menshawy, H.H.EB., Abbas, N.F. et al. Acute kidney injury network criteria as a prognostic factor in cirrhotic patients with spontaneous bacterial peritonitis. Egypt J Intern Med 30, 264–270 (2018). https://doi.org/10.4103/ejim.ejim_15_18
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DOI: https://doi.org/10.4103/ejim.ejim_15_18