Mortality and outcome of acute kidney injury in hospitalized patients with cirrhosis, kidney injury and bacterial infection.

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-04-01 DOI:10.1016/j.aohep.2025.101823

Karina Cazarin-Chávez, Paloma M. Diego-Salazar, Diego F. Abendaño-Rivera, Santiago Camacho-Hernández, Fatima Higuera-De la Tijera, José L. Pérez-Hernández

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Abstract

Introduction and Objectives

Acute kidney injury (AKI) in hospitalized patients with cirrhosis occurs in 60%, is often precipitated and one cause is bacterial infections (BI), worsening the course of cirrhosis. The aim of this work is to report mortality and renal function outcomes in patients with cirrhosis, AKI and IB.

Materials and Patients

We analyzed a retrospective cohort from August 2022 to January 2023 with 201 patients (55.42±10.41 years, 52.7% men). We included patients with a diagnosis of decompensated cirrhosis secondary to different precipitants, including IB, who did or did not develop AKI. We report the frequency of AKI associated with IB and divide the population between those who presented with IB and those who did not. Qualitative data are expressed as percentages and quantitative data as mean±SD. Statistical comparison was performed with the two-tailed unpaired Student's t-test or chi-square, as appropriate Alpha=0.05.

Results

The 73 patients with IB (54.48±9.58 years. 54.8% male) did not differ in age or sex compared to the 128 patients without IB (55.95±10.85 years, 51.6% male, p=0.65) (Figure 1). Patients with IB had a higher risk of mortality at 28 (42.5% vs. 6.3%, p<0.0001) and 90 days (50.7% vs. 10.9%, p<0.0001) (figure 2). Of the total patients who developed AKI with IB (78.1% vs. 43%), it was observed that they had the worse outcome of renal function (complete resolution 37%, incomplete resolution 9.6% and no resolution 31.5% vs 32.8%, 2.3% and 7.8%, p=0.0036), more days of in-hospital stay (7.64±5.31 days vs. 4.23±3.29, p<0. 0001) and analyzing risk factors, they also had significantly higher creatinine numbers (2.26±1.38 vs. 1.43±1.01, p<0.0001), as well as Child Pugh scores (A=1. 4%, B=15.1% and C= 83.6% vs. 18.8%, 46.1% and 35.2%, p<0.0001), MELD Na (27.22±8.38 vs. 18.85±8.7, p<0.0001) and ACLF grades (1=20.5%, 2=32.9% y 3=13.7% vs. 14.1%, 7.8% y 1.6%, p<0.0001). Urinary tract infection 32 (43.8%) was the most frequent type of infection.

Conclusions

In patients with cirrhosis, AKI associated with IB increases mortality and worsens renal function outcome. Therefore, IB is not only a precipitant of cirrhosis decompensations but also represents a significant risk factor for a severe clinical course.

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肝硬化、肾损伤和细菌感染住院患者急性肾损伤的死亡率和转归。

简介与目的急性肾损伤（AKI）在肝硬化住院患者中发生率为60%，常为沉淀性，其中一个原因是细菌感染（BI），加重肝硬化病程。本研究的目的是报告肝硬化、AKI和ib患者的死亡率和肾功能结局。材料和患者我们分析了2022年8月至2023年1月的回顾性队列，共有201例患者（55.42±10.41岁，52.7%为男性）。我们纳入了诊断为继发于不同沉淀物（包括IB）的失代偿性肝硬化的患者，这些患者有或没有发生AKI。我们报告了与IB相关的AKI的频率，并将人群分为有IB表现和没有IB表现的人群。定性数据以百分比表示，定量数据以mean±SD表示。采用双尾非配对学生t检验或卡方检验进行统计比较，Alpha=0.05。结果73例IB患者（54.48±9.58）年。（54.8%为男性）与128例无IB患者（55.95±10.85岁，51.6%为男性，p=0.65）相比，年龄和性别没有差异（图1）。IB患者的死亡率在28天（42.5% vs. 6.3%, p<0.0001）和90天（50.7% vs. 10.9%, p<0.0001）时更高（图2）。在合并IB的AKI患者中（78.1% vs. 43%），观察到他们的肾功能预后较差（完全消退37%，不完全消退9.6%，无消退31.5% vs. 32.8%， 2.3%和7.8%,p=0.0036），住院天数较长(7.64±5.31天vs. 4.23±3.29天，p=0.0036；0001)并分析危险因素，他们的肌酐值（2.26±1.38 vs. 1.43±1.01,p<0.0001）和Child Pugh评分（A=1）也显著高于对照组。4%, B和C = 83.6%比18.8% = 15.1%,46.1%和35.2%,术中;0.0001),融合Na(27.22±8.38和18.85±8.7,术中;0.0001)和ACLF成绩(1 = 20.5%,2 = y 3 = 13.7%比14.1%,32.9% 7.8% 1.6%,术中;0.0001)。尿路感染32例（43.8%）是最常见的感染类型。结论在肝硬化患者中，AKI合并IB会增加死亡率并恶化肾功能结局。因此，IB不仅是肝硬化失代偿的前兆，也是严重临床病程的重要危险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.