Evaluation of the criteria of hepatorenal syndrome type of acute kidney injury in patients with cirrhosis admitted to ICU

Abstract

Introduction: Acute kidney injury (AKI) is a common and devastating complication in patients with cirrhosis. In 2015, the International Club of Ascites (ICA) proposed the definition of hepatorenal syndrome (HRS) type of AKI (HRS-AKI) in patients with cirrhosis. This study aims to evaluate the criteria of HRS-AKI in patients with cirrhosis admitted to ICU with regard to the prognosis.

Methods: A total of 349 cirrhotic patients consecutively admitted to intensive care unit (ICU) from 2010 to 2017 were retrospectively analyzed. Demographic parameters and clinical variables were collected with case report forms. The occurrence of AKI was determined according to ICA-AKI criteria. The phenotypes of AKI comprised pre-renal azotemia (PRA), acute tubular necrosis (ATN) and HRS. In our study, patients with PRA or ATN were classified to the non-HRS-AKI group.

Results: The incidence of AKI was 73.0%, comprising PRA (18.6%), ATN (16.3%) and HRS (38.1%). The overall hospital mortality was 64.5%. Patients with AKI had a significantly higher in-hospital (76.1%) and 180-d (86.7%) mortality. AKI type was an independent risk factor for in-hospital mortality by a multivariate logistic regression. The in-hospital and 180-d mortality rates were of no significant difference among patients with HRS-AKI stages 1–3.

Conclusions: AKI is common in patients with cirrhosis admitted to ICU, associated with significant in-hospital mortality. HRS-AKI was the most common and severe type of AKI in patients with cirrhosis admitted to ICU. The current staging system may not be applicable for HRS-AKI in patients with cirrhosis admitted to ICU.

Keywords:

• Acute kidney injury
• hepatorenal syndrome
• cirrhosis
• intensive care unit

Acknowledgments

The authors gratefully acknowledge Mrs. Junnan Li for her assistance with data analysis and technical graphics.

Ethics approval and consent to participate

This clinical study was conducted in compliance with the ethical principles of the Declaration of Helsinki and its later amendments. The Ethics Committee of Beijing Ditan Hospital approved our study protocol (approval no. KY2016-022). As a de-identified retrospective study, the ethics committee did not require us to obtain written or verbal informed consent from participants.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability

The data that support the findings of this study are available from the corresponding author, AL, upon reasonable request.

Additional information

Funding

This work was supported by The Research Award Fund for Clinical Medicine of Beijing Hospital Authority, China [Grant No: ZYLX201802]