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Acute kidney injury common among patients with ALD hospitalized for ACLF
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HONOLULU — In a liver plenary session at ACG 2015, Sujan Ravi, MD, MPH, clinical assistant professor, University of Alabama at Birmingham, presented clinical data that found acute kidney injury to be common among patients with alcoholic liver disease hospitalized for acute-on-chronic liver failure.
“Alcoholic liver disease accounts for around 50% of patients with acute-on-chronic liver failure. As we all know, acute-on-chronic liver failure in alcoholic liver disease can either be from alcoholic hepatitis or reasons other than alcoholic hepatitis. … Acute kidney injury is frequent among patients with acute-on-chronic liver failure,” Ravi said during his presentation. “With this background in mind, we designed our study to examine the incidence of acute kidney injury in patients with acute-on-chronic liver failure and also evaluate the predictors of acute kidney injury among patients with acute-on-chronic liver failure. We also tried to assess the impact of acute kidney injury in outcomes of patients with acute-on-chronic liver failure.”
Sujan Ravi
Ravi and colleagues, including Ashwani Singal, MD, MS, FACG, assistant professor, department of medicine, University of Alabama at Birmingham, evaluated medical charts of 104 patients with alcoholic cirrhosis meeting acute-on-chronic liver failure (ACLF) criteria and 112 patients with alcoholic hepatitis (AH) discharged from the hospital after their diagnoses. Various outcomes were measured, including length of hospital stay, requirement of ICU care, in-hospital mortality and readmission within 30 days of hospitalization, according to Ravi’s presentation.
Overall, 70% of all 216 patients presented with acute kidney injury (AKI) at admission or during hospitalization (n = 151). These patients were older in age (53 years vs. 46 years; P < .0001), mostly male gender (76% vs. 57%; P = .006), and had higher proportion of patients with cirrhosis (83% vs. 58%; P = .0004), ascites (63% vs. 46%; P = .02), hepatic encephalopathy (58% vs. 39%; P = .029), higher admission bilirubin (14 vs. 10 mg/dL; P = .02) compared with the patients without AKI.
The patients with alcoholic liver disease (ALD) with ACLF were more likely to develop AKI due to non-AH causes compared with patients with AH (47% vs. 12%; Log Rank P = .03).
Analysis from a logistic regression model found age (OR = 1.06; 95% CI, 1.01-1.107), MELD score (OR = 1.19; 95% CI, 1.11-1.28) and non-AH cause for decompensation (OR = 7.1; 95% CI, 2.4-24.4) to be predictors for developing AKI.
The patients with AKI had a longer length of hospital stay (7 days vs. 13 days; P = .002) and higher requirement of ICU care ( 42% vs. 25%; P = .04) compared with patients without AKI. In addition, patients with AKI were more likely to have a higher in-hospital mortality rate (54% vs 40%; P = .054) and 30-day readmission rate out of 108 patients discharged alive (29% vs. 18%; P = .2) compared with patients without AKI.
Ravi concluded: “AKI frequently occurs among ALD patients hospitalized for ACLF. Development of AKI is associated with higher morbidity, mortality and use of hospital resources. Studies are suggested as basis for developing strategies to prevent and decrease AKI among ALD patients hospitalized with ACLF.” – by Melinda Stevens
Reference:
Ravi S, et al. Abstract 66. Presented at: ACG; Oct. 16-21, 2015; Honolulu.
Disclosures: The researchers report no relevant financial disclosures.