Higher Baseline Serum Creatinine Increases Mortality for Hospitalized Patients with Cirrhosis

by Joseph Esherick, M.D., FAAFP, FHM

The International Ascites Club (IAC) recently defined Stage 1 acute kidney injury (AKI) for cirrhosis as an acute increase in serum creatinine (SCr) by ≥0.3mg/dl or by more than 50% in <48h from a stable value within 3 months. 

North American Consortium for the Study of End-Stage Liver Disease is a consortium of tertiary-care hepatology centers prospectively enrolling hospitalized patients with cirrhosis. This study evaluated cirrhotic patients with different baseline SCr levels (≤0.5, 0.51–1.0, 1.01–1.5, >1.5mg/dl) to see if different baseline SCr levels help determine the 30-day mortality rates.

The consortium examined 653 hospitalized cirrhotics with mean age of 56 years, 64% men, and 30% with infection. The incidence of AKI was 47% of the enrolled patients. Patients with higher baseline SCr were more likely to develop AKI as defined by increase in SCr by ≥0.3mg/dl or by a level more than 50% above the baseline SCr.  Multivariate logistic regression showed that a change in SCr during an AKI episode to be the strongest factor impacting AKI outcomes and survival (P<0.001), with an increase in SCr of at least 0.70mg/dl having a 68% sensitivity and 80% specificity for predicting 30-day mortality.  This rise in SCr of at least 0.7 mg/dl also doubled the 30-day mortality (odds ratio, 2.0) compared with cirrhotic inpatients without AKI.

Admitted cirrhotic patients with higher baseline SCr are at higher risk for worsening AKI which correlates with an increased 30-day mortality.

Paracentesis in cirrhotic patient with acute kidney injury

Wong F et al. Acute kidney injury in cirrhosis: Baseline serum creatinine predicts patient outcomes. Am J Gastroenterol 2017 Apr 25