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Abstract: TH-PO063

Mortality and AKI Severity in Cirrhosis: Model for End-Stage Liver Disease Score and Bilirubin Predictive, HRS-1 as AKI Etiology Not Predictive

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Sultan, Mohammad Tanvir, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Varghese, Vipin, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Chalmers, Dustin, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Cacioppo, Paula Anne, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Ochsner Medical Center, New Orleans, Louisiana, United States

Group or Team Name

  • Ochsner Nephrology
Background

End-stage liver disease (ESLD) carries high morbidity and mortality, particularly among those who develop acute kidney injury (AKI). There is conflicting data regarding factors associated with poor outcomes, including studies examining etiology of AKI [hepatorenal syndrome type 1 (HRS-1) vs acute tubular injury (ATI)] as factor. Moreover, prognostic value of findings from microscopic examination of urinary sediment (MicroExUrSed) in patients with ESLD with AKI has not been examined. We hypothesized that illness severity factors (rather than type of injury) are associated with worse outcomes in this patient population.

Methods

We established prospective data collection in patients with ESLD with AKI stage ≥ 2 (AKIN) over 3-years. Demographic and clinical data including Model for End-stage Liver Disease (MELD) score were collected. Each patient completed MicroExUrSed. Presence of hyaline casts (HC), waxy casts (WxC), renal tubular epithelial cell casts (RTECC), granular casts (GC), and muddy brown granular casts (MBGC) were recorded. All parameters were assessed for the relative risk (RR) of reaching a compositive endpoint (CP) of death/hospice at discharge or need for renal replacement therapy (RRT). Analysis was repeated for RRT alone as secondary end point.

Results

We included 185 patients [37% women, 75% white, 16% black, median age 57 (25-87)]. Higher MELD score was associated with greater RR of reaching the CP, RR 1.24 (1.04-1.50), p=0.01. Total bilirubin level was also associated with greater RR of reaching the CP, RR 1.23 (1.01-1.50), p=0.03. Neither age, sex nor race were predictive. HRS-1 was not associated with higher mortality compared to ATI (1.09, p=0.36). Neither HC, WxC, RTECC, GC nor MBGC were independently associated with higher risk for the CP. Regarding RRT as sole endpoint, only total bilirubin level trended towards an increased risk, RR 1.37 (0.98-1.91), p=0.06.

Conclusion

Higher MELD score and total bilirubin levels were associated with greater risk for poor clinical outcomes in patients with ESLD with AKI, whereas HRS-1 as the etiology of AKI did not confer greater risk of mortality or need for RRT compared to ATI. Altogether, these data suggest that in ESLD, severity of illness is the main driver for ominous outcomes rather than the type of AKI.