Abstract: SA-PO156
Similarity of Outcomes in Hepatorenal Syndrome and Other Forms of AKI in Cirrhosis
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - III
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Rivera, Maria Soledad, Ochsner Clinic Foundation, New Orleans, Louisiana, United States
- Velez, Juan Carlos Q., Ochsner Clinic Foundation, New Orleans, Louisiana, United States
Background
Recent data suggests that severe AKI from either hepatorenal syndrome type-1 (HRS-1) or acute tubular injury (ATI) may carry similar mortality, challenging the previous notion of a more ominous prognosis in HRS-1. However, those studies are confounded by uncertainties in adjudication of diagnosis imposed by retrospective designs and by the inherent limitations of the International Club of Ascites (ICA) criteria. Thus, we aimed to examine outcomes of AKI in cirrhosis via a prospective design.
Methods
We established prospective data collection in cirrhotics with AKI stage ≥ 2 (AKIN) over 1.5-years. To reduce uncertainty in diagnosis, we supplemented the standard ICA criteria for HRS-1 with supportive phenotypic criteria: urine Na <20 mEq/L, urine volume <500 ml, mean arterial pressure <80 mmHg, serum Na <135 mEq/L and absence of evidence of ATI by urine sediment microscopy (MicrExUrSed) using the Chawla score (CS). “Definite HRS-1” (Def-HRS) was assigned to those who met all ICA and supportive criteria. “No HRS-1” (No-HRS) was assigned to those with ≥1 unmet ICA criteria or CS for ATI. “Possible HRS-1” (Poss-HRS) was assigned to those who met the ICA criteria but either did not meet all supportive criteria, lacked MicrExUrSed or had a CS equivocal for ATI. Outcomes chosen: need for dialysis (RRT), discharge to hospice (Hosp), liver transplant (LT) and death at 1, 3- and 6-months post-AKI.
Results
We included 133 patients [40% women, age 58 (25-87)] in our cohort. MicrExUrSed was done in 88 (66%) patients. We categorized 29 (22%) patients as Def-HRS, 24 (18%) as Poss-HRS and 80 (60%) as No-HRS. Baseline serum creatinine [2.6 (2-4.1), 2.4 (2-3) and 2.8 (2.3-3.6) mg/dL] and bilirubin [5.6 (2.3-15.6), 5.4 (2.1-14.6) and 5.6 (2.3-14.5) mg/dL] were comparable for the 3 groups. At 30 days, need for RRT was 38%, 21% and 36% and for Hosp 41%, 33% and 28%, for Def-HRS, Poss-HRS and No-HRS, respectively. Mortality rates at 1, 3 and 6 months were: Def-HRS: 21%, 21% and 24%; Poss-HRS: 29%, 33% and 42%; and No-HRS: 35%, 43% and 44%, respectively. At 6 months, LT occurred in 15%, 17%, and 24% for each of the 3 groups, respectively.
Conclusion
Our prospective cohort with stringent adjudication of diagnosis indicates that HRS-1 is not associated with more ominous clinical outcomes compared to other forms of AKI in cirrhosis.