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Abstract：
OBJECTIVE: Participants at a consensus conference proposed defining cirrhosis-associated acute kidney injury (AKI) based on a >50% increase in serum creatinine level from the stable baseline value in <6 months or an increase of ≥ 0.3 mg/dL in <48 hours. We performed a prospective study to evaluate the ability of these criteria to predict mortality within 30 days of hospitalization among patients with cirrhosis and infection.
METHODS: We followed up 337 patients with cirrhosis who were admitted to the hospital with an infection or developed an infection during hospitalization (56% men; 56 ± 10 years of age; Model for End-Stage Liver Disease [MELD] score, 20 ± 8) at 12 centers in North America. We compared data on 30-day mortality, length of stay in the hospital, and organ failure between patients with and without AKI.
RESULTS: In total, based on the consensus criteria, 166 patients (49%) developed AKI during hospitalization. Patients who developed AKI were admitted with higher Child-Pugh scores than those who did not develop AKI (11.0 ± 2.1 vs 9.6 ± 2.1; P < .0001) as well as higher MELD scores (23 ± 8 vs 17 ± 7; P < .0001) and lower mean arterial pressure (81 ± 16 vs 85 ± 15 mm Hg; P < .01). Higher percentages of patients with AKI died within 30 days of hospitalization (34% vs 7%), were transferred to the intensive care unit (46% vs 20%), required ventilation (27% vs 6%), or went into shock (31% vs 8%); patients with AKI also had longer stays in the hospital (17.8 ± 19.8 vs 13.3 ± 31.8 days) (all P < .001). Of the AKI episodes, 56% were transient, 28% were persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%) compared with partial (40%) or complete recovery (15%) or those who did not develop AKI (7%; P < .0001).
CONCLUSIONS: Among patients with cirrhosis, 30-day mortality is 10-fold higher among those with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure.
METHODS: We followed up 337 patients with cirrhosis who were admitted to the hospital with an infection or developed an infection during hospitalization (56% men; 56 ± 10 years of age; Model for End-Stage Liver Disease [MELD] score, 20 ± 8) at 12 centers in North America. We compared data on 30-day mortality, length of stay in the hospital, and organ failure between patients with and without AKI.
RESULTS: In total, based on the consensus criteria, 166 patients (49%) developed AKI during hospitalization. Patients who developed AKI were admitted with higher Child-Pugh scores than those who did not develop AKI (11.0 ± 2.1 vs 9.6 ± 2.1; P < .0001) as well as higher MELD scores (23 ± 8 vs 17 ± 7; P < .0001) and lower mean arterial pressure (81 ± 16 vs 85 ± 15 mm Hg; P < .01). Higher percentages of patients with AKI died within 30 days of hospitalization (34% vs 7%), were transferred to the intensive care unit (46% vs 20%), required ventilation (27% vs 6%), or went into shock (31% vs 8%); patients with AKI also had longer stays in the hospital (17.8 ± 19.8 vs 13.3 ± 31.8 days) (all P < .001). Of the AKI episodes, 56% were transient, 28% were persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%) compared with partial (40%) or complete recovery (15%) or those who did not develop AKI (7%; P < .0001).
CONCLUSIONS: Among patients with cirrhosis, 30-day mortality is 10-fold higher among those with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure.
摘要：
目的：在一个共识会议上，与会者提出定义肝硬化相关急性肾损伤（AKI）基于血清肌酐水平在<6个月内从稳定基线值增加>50％或在<48小时内增加≥0.3mg/dL。我们进行了一项前瞻性研究，以评估这些标准预测肝硬化和感染患者住院后30天内死亡率的能力。
方法：我们随访了337例肝硬化患者，这些患者因感染入院或住院期间发生感染（56％为男性；56±10岁；终末期肝病模型[MELD]评分，20±8）在北美的12个中心。我们比较了30天死亡率的数据，住院时间,有和没有AKI的患者之间的器官衰竭。
结果：总计，基于共识标准，166例患者（49%）在住院期间发生AKI。发生AKI的患者入院时Child-Pugh评分高于未发生AKI的患者（11.0±2.1vs9.6±2.1；P<.0001），MELD评分更高（23±8vs17±7；P<.0001），平均动脉压更低（81±16vs85±15mmHg；P<.01）。AKI患者在住院后30天内死亡的百分比更高（34％vs7％），被转移到重症监护病房(46%对20%)，所需通风(27%对6%)，或休克（31％vs8％）；AKI患者的住院时间也更长（17.8±19.8vs13.3±31.8天）（均P<.001）。在AKI事件中，56%是短暂的，28%是持续性的，16％导致透析。与部分（40％）或完全恢复（15％）或未发生AKI的患者（7％；P<0.0001）相比，无肾脏恢复的患者的死亡率更高（80％）。
结论：在肝硬化患者中，不可逆AKI患者的30天死亡率比无AKI患者高10倍。AKI的共识定义准确地预测了30天的死亡率，住院时间,器官衰竭。
方法：我们随访了337例肝硬化患者，这些患者因感染入院或住院期间发生感染（56％为男性；56±10岁；终末期肝病模型[MELD]评分，20±8）在北美的12个中心。我们比较了30天死亡率的数据，住院时间,有和没有AKI的患者之间的器官衰竭。
结果：总计，基于共识标准，166例患者（49%）在住院期间发生AKI。发生AKI的患者入院时Child-Pugh评分高于未发生AKI的患者（11.0±2.1vs9.6±2.1；P<.0001），MELD评分更高（23±8vs17±7；P<.0001），平均动脉压更低（81±16vs85±15mmHg；P<.01）。AKI患者在住院后30天内死亡的百分比更高（34％vs7％），被转移到重症监护病房(46%对20%)，所需通风(27%对6%)，或休克（31％vs8％）；AKI患者的住院时间也更长（17.8±19.8vs13.3±31.8天）（均P<.001）。在AKI事件中，56%是短暂的，28%是持续性的，16％导致透析。与部分（40％）或完全恢复（15％）或未发生AKI的患者（7％；P<0.0001）相比，无肾脏恢复的患者的死亡率更高（80％）。
结论：在肝硬化患者中，不可逆AKI患者的30天死亡率比无AKI患者高10倍。AKI的共识定义准确地预测了30天的死亡率，住院时间,器官衰竭。
