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Evaluation of acute kidney injury and its response to terlipressin in patients with acute‐on‐chronic liver failure
Author(s) -
Jindal Ankur,
Bhadoria Ajeet S.,
Maiwall Rakhi,
Sarin Shiv K.
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12895
Subject(s) - terlipressin , medicine , hepatorenal syndrome , acute kidney injury , gastroenterology , hepatic encephalopathy , rifle , odds ratio , ascites , cirrhosis , archaeology , history
Abstract Background & aims Patients with acute‐on‐chronic liver failure ( ACLF ) have high mortality. Cirrhotics with acute kidney injury ( AKI ) have poor outcome but relevance of AKI and response to terlipressin in ACLF is not known. Methods Consecutive ACLF patients with AKI at admission were compared with those without AKI (controls) for mortality at day 7, month 1 and 3, presence of hepatic encephalopathy ( HE ), spontaneous bacterial peritonitis ( SBP ) and acute variceal bleed ( AVB ). Patients were also compared based on severity of AKI (mild; S.cr 1.5–3 mg/dl and marked; S.cr >3 mg/dl). Response to terlipressin was also evaluated. Results Of 241 ACLF patients, 55 (22.8%) had AKI at admission. Patients with AKI had higher mortality at day 7, 1 and 3 month and more often developed HE [54.1% vs. 30.6%; P = 0.001] and SBP [9.1% vs. 5.9%; P = 0.02]. Patients with marked AKI neither had higher mortality or complications in comparison to mild AKI . Presence of AKI [Odds ratio; OR , 2.4], S.bilirubin >20 mg/dl [ OR , 3.1] and INR [ OR , 2.9] were independent baseline predictors of mortality. Terlipressin was used in 28 of 55 patients with AKI who were volume non‐responsive (hepatorenal syndrome, AKI ‐ HRS ). Ten (35.7%) of these showed response (S.Cr < 1.5 mg/dl) [median 4 days] and had lower mortality compared to terlipressin non‐responders (10% vs. 50%, P = 0.05). There was no difference in terlipressin response in mild vs. marked AKI . Conclusions Almost one‐fourth of the ACLF patients have AKI at admission and presence of AKI , but not its severity predicts complications and high mortality. Terlipressin effectively reverses AKI ‐ HRS within a week in ~35% of ACLF patients resulting in improved survival.