1095 Presence of Acute Kidney Injury (AKI) at Admission in Severe Alcoholic Hepatitis (SAH) Patients Predicts Mortality: A Single Centre Experience

Abstract

INTRODUCTION: Severe Alcoholic Hepatitis (SAH) is a life-threatening condition. There are different models to prognosticate patients with SAH. However, the impact of presence of acute kidney injury (AKI), defined as per AKIN criteria in patients with SAH has not been assessed for this region of Asia. Hence we performed a prospective study to evaluate the spectrum of SAH including outcome in hospitalized patients and the impact of AKI on outcome of patients with SAH. METHODS: This study was conducted on consecutive alcoholic hepatitis (AH) patients hospitalised in Gastroenterology Department, SCB Medical College, Cuttack, India between October 2016 and October 2018. On diagnosis of AH, modified Maddrey discriminant function (mDF) was used to detect SAH (mDF score ≥32).Demographic, clinical and laboratory parameters were recorded and survival was compared between patients with and without AKI (as per AKIN criteria) during hospitalisation and also at 28 days and 90 days. RESULTS: 339 patients of AH were included in the study. Out of them, 236 (70%) patients had SAH (DF ≥ 32) and 103 patients (30%) had DF < 32.All patients with SAH were males. 164 (69%) patients with SAH had AKI and72 (31%) did not have AKI at hospitalisation. On comparison between SAH patients with or without AKI, age was comparable between the two groups. However, patients with SAH and AKI had higher MELD UNOS (28.69 ± 8.36 vs 19.50 ± 3.83; P < 0.001), MELD Na+ (30.44 ± 7.56 vs 22.97 ± 4.56; P < 0.001), CTP score (12.46 ± 1.84 vs 11.93 ± 1.50; P = 0.033), DF ((71.18 vs 53.24,IQR; P < 0.001) and ABIC score (3.37 ± 1.47 vs 2.26 ± 0.61; P < 0.001). Furthermore, they had increased prevalence of ACLF as per CANONIC study criteria (73.2% vs 34.7%; P < 0.001), increased duration of hospitalisation (5days vs 4days,IQR; P < 0.001) and decreased survival both at 28days (57.9% vs 80.6%; P < 0.001) and 90days (36% vs 55.6%; P = 0.005). Kaplan–Meier survival curves showed significant differencesin survival between patients with and without AKI both at 28 days (log rank P value < 0.001) and 90 days (log rank P value < 0.001) (Figure 1). CONCLUSION: In our institution, over three fourth of alcoholic liver disease patients had severe AH and three fourth of them had AKI at admission. Patients with AH and AKI had increased proportion of ACLF, longer hospital stay, and decreased survival both at day 28 and 90.