Global epidemiology of acute kidney injury in hospitalised patients with decompensated cirrhosis: the International Club of Ascites GLOBAL AKI prospective, multicentre, cohort study
Background Acute kidney injury (AKI) is a serious complication of cirrhosis. A systematic, global characterisation of AKI occurring in patients with cirrhosis is lacking. We therefore aimed to assess global differences in the characteristics, management, and outcomes of AKI in hospitalised patients...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Institut d'Investigació i Innovació Parc Taulí (I3PT) |
| Repositorio: | r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí |
| OAI Identifier: | oai:i3pt.fundanetsuite.com:p6317 |
| Acceso en línea: | https://i3pt.portalinvestigacion.com/publicaciones/6317 https://www.scopus.com/inward/record.uri?eid=2-s2.0-105002128353&doi=10.1016%2FS2468-1253%2825%2900006-8&partnerID=40&md5=0da314006294714c4047609db705567b |
| Access Level: | acceso abierto |
| Palabra clave: | albumin creatinine acute kidney failure adult Article ascites biogeographic region chronic kidney failure chronic liver disease clinical outcome cohort analysis comorbidity controlled study decompensated liver cirrhosis disease severity estimated glomerular filtration rate female follow up hepatic encephalopathy hospital admission hospitalization human intensive care unit kidney injury length of stay liver transplantation major clinical study male middle aged morbidity mortality multicenter study observational study outcome assessment peritonitis prevalence proportional hazards model prospective study rank sum test renal replacement therapy retrospective study risk factor socioeconomics aged clinical trial complication epidemiology etiology global health liver cirrhosis severity of illness index therapy Acute Kidney Injury Adult Aged Ascites Female Global Health Hospitalization Humans Liver Cirrhosis Male Middle Aged Preval |
| Sumario: | Background Acute kidney injury (AKI) is a serious complication of cirrhosis. A systematic, global characterisation of AKI occurring in patients with cirrhosis is lacking. We therefore aimed to assess global differences in the characteristics, management, and outcomes of AKI in hospitalised patients with cirrhosis. Methods In this prospective, multicentre, cohort study, we enrolled adults (>= 18 years) with decompensated cirrhosis who were hospitalised for a cirrhosis-related complication, with or without AKI, at 65 centres across five continents. We captured AKI prevalence, stage, phenotype, and details on AKI management and clinical course. Universal health coverage index and gross national income per capita were also collected. The primary outcome was 28-day mortality. Multivariable models including demographic and clinical variables, cirrhosis cause, cirrhosis severity, AKI severity, AKI management variables, universal health coverage, and gross national income were used to analyse independent associations with 28-day mortality. Secondary outcomes were AKI classification, progression, and resolution. This study is complete and registered with ClinicalTrials.gov (NCT05387811). Findings Between July 1, 2022, and May 31, 2023, we enrolled 3821 patients who were hospitalised for decompensated cirrhosis. Mean age was 57<middle dot>7 years (SD 13<middle dot>1), 2467 (64<middle dot>6%) were men, and 1354 (35<middle dot>4%) were women. Most patients were White (2128 [55<middle dot>7%]). 1456 (38<middle dot>1%, 95% CI 36<middle dot>6-39<middle dot>6) of 3821 patients had AKI (943 [64<middle dot>8%] men and 513 [35<middle dot>2%] women). Globally, patients presented with similar AKI stages, but patients from North America and Asia had the highest MELD-Na scores at presentation and the highest rates of peak AKI stage 3. Overall, hypovolaemic AKI was the most common phenotype (858 [58<middle dot>9%] of 1456), followed by HRS-AKI (253 [17<middle dot>4%]) and acute tubular necrosis (216 [14<middle dot>8%]). The prevalences of hypovolaemic AKI and HRS-AKI were similar across regions, but acute tubular necrosis was more frequent in Asia (p<0<middle dot>0001 across regions). Additionally, regional differences in the management of AKI (use of albumin, vasopressors, and diuretics) were found. 335 (28<middle dot>6%) of 1171 patients with initial AKI stages 1 or 2 had progression to higher stages during hospitalisation. AKI resolved in 862 (59<middle dot>2%) cases during hospitalisation. 333 (22<middle dot>9%) patients with AKI had died by 28 days. Multivariable analyses showed that increased age, female sex, presence of ascites, presence of hepatic encephalopathy, increased white blood cell count, increased MELD-Na, hospital-acquired AKI, a lower universal health coverage index (<80), and not being in a high-income country were independently associated with an increased risk of 28-day mortality. Increased serum albumin was associated with a decreased risk of 28-day mortality. Interpretation This study found important regional differences in AKI severity, phenotype, management, and outcomes in patients with decompensated cirrhosis. Health-care coverage remains an important driver of survival in patients with cirrhosis and AKI. |
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