Chinese Hepatolgy ›› 2025, Vol. 30 ›› Issue (4): 500-504.

• Liver Fibrosis & Cirrhosis • Previous Articles     Next Articles

The prognosis of decompensated cirrhosis complicated by acute kidney injury: a prospective study based on the ICA-AKI criteria

CHEN Jian1, WANG Gan-Hong2, ZHOU Jing-Jie1, LIU Luo-Jie1, XU Xiao-Dan1   

  1. 1. Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, First People' s Hospital of Changshu city, Changshu 215500, China;
    2. Department of Gastroenterology, Changshu Traditional Chinese Medical Hospital, Changshu 215500, China
  • Received:2024-01-04 Online:2025-04-30 Published:2025-06-17
  • Contact: XU Xiao-dan, Email: szcs10132716@163.com

Abstract: Objective To assess the clinical utility of ICA-AKI diagnostic criteria in cirrhotic patients with acute kidney injury (AKI). Methods A cohort of 217 decompensated cirrhotic patients treated at the First People's Hospital of Changshu City from January 2018 to December 2021 was stratified into an AKI group (n=53) and a non-AKI group (n=164) based on ICA-AKI criteria. Renal injury was staged as 1, 2, and 3 with 32, 16, and 5 cases, respectively. The study compared renal insufficiency across various ages and Child-Pugh scores, with follow-up conducted through outpatient clinics and phone calls until December 2021. Survival rates were computed using the Kaplan-Meier method, with survival analysis performed via Log-rank test and Cox regression analysis employed to investigate mortality determinants in cirrhotic patients with AKI. Results Over four years, hospital admissions rose in both cohorts. The AKI group faced significantly greater average hospitalization expenses compared to the non-AKI group, with a declining trend in the costs of the AKI group over the same period. In contrast to rising morbidity, the hospital mortality rate in the AKI group decreased markedly from 36.5% in 2018 to 12.1% in 2021, whereas the mortality rate in cirrhotic patients without AKI experienced a minor decrease from 6.3% to 3.8%. The incidence of AKI among cirrhotic patients varied significantly with age (7.8% in the 20-40 age group, 25.4% in the 41-60 age group, and 44.4% in those over 60), with a significant statistical difference (χ2=9.42, P<0.05). The Child-Pugh score was notably higher in the AKI group (P<0.001). After the longest follow-up of 49 months, mortality was 18.9% in the AKI group compared to 5.5% in the non-AKI group. Median overall survival was significantly reduced in the AKI group. Notably, common complications such as spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), variceal hemorrhage (VH), ascites in cirrhosis substantially heightened the mortality risk when coinciding with AKI status,(adjusted odds ratios [aOR] of 5.77, 5.49, 7.95, 5.62, respectively). Specifically, the risk of death in VH patients with AKI was more than seven times higher than those without AKI after adjusting for age (aOR 7.89; 95% CI 7.68-8.33). Conclusion The incidence of AKI in hospitalized cirrhotic patients is notably high, and AKI significantly escalates both hospitalization costs and mortality. The implementation of ICA-AKI criteria for assessing renal injury in cirrhosis patients is of vital clinical significance.

Key words: Cirrhosis, Acute Kidney Injury, ICA-AKI Criteria, Prognosis, Survival Analysis