THE ETIOLOGY OF LIVER CIRRHOSIS AND THE RISK OF ACUTE KIDNEY INJURY

Abstract

Background: Acute kidney injury (AKI) is an important complication of liver cirrhosis, that increases the mortality in the cirrhotic patients, usually diagnosed as hepatorenal syndrome (HRS). However, there is no proven link between the etiology of liver cirrhosis and the risk of kidney injury. Methods: We conducted a retrospective study on 171 patients with liver cirrhosis admitted to our clinic during a year. We compared data on Child-Pugh and Meld-Na scores, neutrophil-to-lymphocyte ratio (NLR), serum creatinine, and the estimation of renal dysfunction by using AKIN and ICA-AKI classifications at admission, depending on the etiology of liver cirrhosis. Results: From the 171 patients (110 men, 61 women), 116 (68%) had chronic alcohol abuse as etiology, 38 (22%) hepatitis C virus and 17 (10%) hepatitis B virus. The mean Meld-Na score was 20.53�8.84. 57(49%) patients with alcoholic cirrhosis, 10 (59%) patients with HBV and 20 (53%) patients with HCV, had a class C Child-Pugh score (p value .73, not statistic significant). Comparing NLR, an inflammatory marker and an independent predictor for AKI and mortality, the HBV group had a higher NLR than the other 2 groups (9.17�9.63 vs 6.15� 6.05). Although there was no statistical difference between the creatinine values at admission between the 3 groups (p> .05), we noted a statistical difference of eGFR between patients with hepatitis B and C, compared to those with alcoholic etiology (67.98 �34.4 ml/min vs 81.44�34.9 ml/min, p value less than .05). 10 (26%) patients with HCV, 6 (35%) patients with HBV and 15 (13%) patients with alcoholic liver cirrhosis developed AKI (p value less than .05). Conclusions: In conclusion, the viral etiology of liver cirrhosis may be more frequently associated with the risk of acute kidney injury, in comparison with alcoholic cause, but larger studies are needed.