Predictors of Short-term Mortality in Patients of Cirrhosis of Liver Presenting as Acute Kidney Injury: An In-hospital Prospective Observational Study

Abstract

Acute kidney injury is known to be associated with increased short-term mortality among cirrhotic patients. On this background, we designed this study to evaluate various causes of AKI among admitted patients with cirrhosis of liver and predictors of 90-day mortality.MethodsOne hundred and two consecutive adult patients with cirrhosis of liver with AKI hospitalised between November 2016 and March 2018 were enrolled for this prospective study. Their detailed clinical profile including biochemical parameters, etiology of AKI and their clinical outcome of survival or mortality at 90-days were recorded.ResultsThe most common causes of AKI were infections followed by hypovolemia seen in 55.88% and 31.37% of the patients respectively. Hepatorenal syndrome was seen in 10.78% while parenchymal renal disease was least common (1.9%). In-hospital mortality rate was 28.4 %, while 90-day mortality was 39.21 %. HRS group had high 90-day mortality at 54.54%. ROC analysis of various biochemical parameters revealed that sCr, MELD, INR, NLR followed by CTP had high area under curve of 0.785, 0.773, 0.747, 0.740 and 0.718 respectively for prediction of 90-day mortality.ConclusionInfection is the commonest cause of AKI in cirrhosis; however, mortality in patients with HRS-AKI is higher than those with infection-related AKI. Serum creatinine at admission, INR, NLR and CTP scores predict short-term mortality among patients with AKI in cirrhosis. Further large prospective studies are needed to confirm these findings.