Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites

Background & Aims: For several years hepatologists have defined acute renal failure in patients with cirrhosis as an increase in serum creatinine (sCr) >= 50% to a final value of sCr > 1.5 mg/dl (conventional criterion). Recently, the Acute Kidney Injury Network (AKIN) defined acute renal failure as acute kidney injury (AKI) on the basis of an absolute increase in sCr of 0.3 mg/dl or a percentage increase in sCr >= 50% providing also a staging from 1 to 3. AKIN stage 1 was defined as an increase in sCr >= 0.3 mg/dl or increase in sCr >= 1.5-fold to 2-fold from baseline. AKI diagnosed with the two different criteria was evaluated for the prediction of in-hospital mortality. Methods: Consecutive hospitalized patients with cirrhosis and ascites were included in the study and evaluated for the development of AKI. Results: Conventional criterion was found to be more accurate than AKIN criteria in improving the prediction of in-hospital mortality in a model including age and Child-Turcotte-Pugh score. The addition of either progression of AKIN stage or a threshold value for sCr of 1.5 mg/dl further improves the value of AKIN criteria in this model. More in detail, patients with AKIN stage 1 and sCr < 1.5 mg/dl had a lower mortality rate (p = 0.03), a lower progression rate (p = 0.01), and a higher improvement rate (p = 0.025) than patients with AKIN stage 1 and sCr >= 1.5 mg/dl. Conclusions: Conventional criterion is more accurate than AKIN criteria in the prediction of in-hospital mortality in patients with cirrhosis and ascites. The addition of either the progression of AKIN stage or the cut-off of sCr >= 1.5 mg/dl to the AKIN criteria improves their prognostic accuracy. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.