Determinants of Short-term Mortality in Liver Cirrhosis with Acute Kidney Injury: A Prospective Observational Study

Abstract

Background:

Acute kidney injury (AKI) occurs in 20-50% of patients with cirrhosis and is associated with a poor prognosis.

Aim: To identify the baseline factors affecting mortality in these patients at 30 and 90 days.

Methods:

We enrolled 117 patients with cirrhosis and AKI and followed them up prospectively.

Results:

Distribution of International club of ascites AKI stages was: 26 (22.03%) stage 1, 59 (50%) stage 2, and 33 (28%) stage 3. Mortalities at 30 and 90 days were 27 (22.8%) and 33 (27.9%) respectively. On multivariate analysis, variables affecting mortality at 30 days were serum creatinine level >2 mg% at 48 hours after AKI development (adjusted OR 7.93, P=0.02) and leucocytosis (total leucocyte count>11,000/mm³) at admission (adjusted OR 6.54, P=0.002). Only leucocytosis at admission was a predictor of 90 days mortality (adjusted OR 4.76, P=0.01). Though not statistically significant, patients not responding to standard medical treatment had 3 times higher mortality at 30 days, while the maximum AKI stages (2 and 3) had eight times higher mortality at 90 days.

Conclusion:

In cirrhosis, AKI increases short-term mortality. High serum creatinine at 48 hours affects mortality at 30 days, while leucocytosis at baseline predicts mortality at 30 and 90 days. Progression to a higher AKI stage impacts prognosis.