Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Design
2.2. Data Collection and Definitions
2.3. Statistical Analysis
3. Results
3.1. Patient Demographics, Baseline Characteristics and Outcomes
3.2. Correlation of Patient Characteristics and Outcomes for HRS-AKI vs. no HRS-AKI
3.3. Odds for Development of Hepatorenal-AKI
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | n = 529 n (%) or Mean (SD) |
---|---|
Age (years) | 65 (12) |
Gender (female) | 199 (37.6%) |
Race | |
White/Caucasian | 296 (56%) |
African American/Black | 83 (15.7%) |
Asian | 41 (7.8%) |
Other | 91 (17%) |
Not specified/unavailable | 18 (3.4%) |
Cirrhosis etiology 1 | |
Alcoholic | 233 (44%) |
Non-alcoholic steatohepatitis | 130 (24.6%) |
Hepatitis C virus (HCV) | 105 (19.6%) |
Hepatitis B virus (HBV) | 8 (1.5%) |
Cryptogenic/other 2 | 66 (12.5%) |
Charleson comorbidity index score | 3 (2) |
Chronic kidney disease | 95 (17.9%) |
History of ascites | 207 (39.1%) |
Ascites present on admission | 183 (34.6%) |
Ascites grade 1 | 80 (15.1%) |
Ascites grade 2 | 64 (12.1%) |
Ascities grade 3 | 39 (7.4%) |
History of hepatic encephalopathy | 187 (35.3%) |
History of esophageal varices | 176 (33.3%) |
Clinical signs of portal hypertension | 353 (66.7%) |
Non-selective beta-blocker use during admission | 169 (31.9%) |
Vital signs | |
Body mass index | 29.7 (11.3) |
Systolic blood pressure | 121 (26) |
Diastolic blood pressure | 68 (12) |
Hemoglobin (g/dL) | 10.8 (2.4) |
Platelet count (×103) | 160 (107) |
Sodium (meq/L) | 135 (6) |
Creatinine (mg/dL) | 2.1 (1.6) |
Albumin (g/dL) | 3.2 (0.6) |
Bilirubin (mg/dL) | 2.1 (3.9) |
International normalized ratio (INR) | 1.6 (1.0) |
MELD score | 18 (7) |
MELD-Na score | 19 (8) |
Infection identified 3 | 203 (38.4%) |
UTI/pyelonephritis | 51 (9.6%) |
Pneumonia/respiratory infections | 36 (6.8%) |
Cellulitis/other skin infections | 30 (5.7%) |
Spontaneous bacterial peritonitis | 31 (5.9%) |
Bacteremia | 22 (4.2%) |
Colitis/enteritis (other than clostridium difficile) | 12 (2.3%) |
Clostridium difficile | 9 (1.7%) |
Cholecytitis | 7 (1.3%) |
Other 4 | 13 (2.5%) |
Cause of AKI | |
Pre-renal | 189 (35.7%) |
Intrinsic | 55 (10.4%) |
Hepato-renal syndrome | 52 (9.8%) |
Cardiorenal | 39 (7.4%) |
Postrenal | 10 (1.9%) |
Unidentified | 20 (3.8%) |
Received Albumin | 117 (22.1%) |
Received octreotide | 102 (19.3%) |
Vasopressor requirement | 89 (16.8%) |
Mechanical ventilation requirement | 77 (14.6%) |
Hemodialysis requirements | 17 (3.2%) |
Hospital length of stay | 10 (9) |
Death | 59 (11.2%) |
Variables | Development of Hepato-Renal Syndrome | p-Value | |
---|---|---|---|
Yes (n = 52) n (%) or Mean (SD) | No (n = 477) n (%) or Mean (SD) | ||
Age (years) | 63.2 (9.7) | 65.5 (12.6) | 0.191 |
Gender (female) | 24 (36.2%) | 175 (36.7%) | 0.361 |
Race | |||
White/Caucasian | 27 (52%) | 269 (56.4%) | 0.751 |
African American/Black | 9 (17.3%) | 74 (15.5%) | |
Asian | 4 (7.7%) | 37 (7.8%) | |
Other | 9 (17.3%) | 82 (17.2%) | |
Not specified/unavailable | 3 (5.8%) | 15 (3.2%) | |
Cirrhosis etiology | |||
Alcoholic | 31 (59.6%) | 202 (42.3%) | <0.05 |
Non-alcoholic steatohepatitis | 7 (13.5%) | 123 (25.8%) | 0.05 |
Hepatitis C virus (HCV) | 10 (19.2%) | 95 (19.9%) | 0.906 |
Hepatitis B virus (HBV) | 2 (3.8%) | 6 (1.3%) | 0.146 |
Cryptogenic/other | 3 (5.8%) | 61 (12.8%) | 0.141 |
Charleson comorbidity index score | 3 (2) | 3 (2) | 0.206 |
Chronic kidney disease | 5 (9.6%) | 90 (18.9%) | 0.099 |
History of ascites | 39 (75.0%) | 165 (34.6%) | <0.05 |
Ascities present on admission | 42 (80.8%) | 141 (29.6%) | <0.05 |
Ascities grade 1 | 7 (16.7%) | 73 (51.8%) | <0.05 |
Ascities grade 2 | 18 (34.6%) | 46 (9.6%) | |
Ascities grade 3 | 17 (40.5%) | 22 (15.6%) | |
History of hepatic encephalopathy | 32 (61.5%) | 155 (32.5%) | <0.05 |
History of esophageal varices | 17 (32.7%) | 159 (33.3%) | 0.926 |
Clinical signs of portal hypertension | 47 (90.4%) | 306 (64.2%) | <0.05 |
Non selective beta blocker use during hospitalization | 12 (23.1%) | 157 (32.9%) | 0.149 |
Vital signs | |||
Body mass index | 28.2 (6.7) | 29.9 (11.7) | 0.367 |
Systolic blood pressure | 115 (26) | 122 (26) | 0.057 |
Diastolic blood pressure | 64 (18) | 68 (16) | 0.059 |
Hemoglobin (g/dL) | 10.0 (1.8) | 10.9 (2.5) | <0.05 |
Platelet count (×103) | 129 (102) | 164 (107) | <0.05 |
Sodium (meq/L) | 131 (6) | 136 (6) | <0.05 |
Creatinine (mg/dL) | 2.7 (2.0) | 2.0 (1.6) | <0.05 |
Albumin (g/dL) | 2.8 (0.5) | 3.2 (0.6) | <0.05 |
Bilirubin (mg/dL) | 3.4 (4.0) | 1.9 (3.9) | <0.05 |
International Normalized Ratio (INR) | 1.9 (0.8) | 1.6 (1.0) | <0.05 |
MELD score | 24 (7) | 17 (7) | <0.05 |
MELD-Na score | 27 (7) | 19 (7) | <0.05 |
Infection identified | 25 (48.1%) | 175 (36.8%) | 0.113 |
UTI/pyelonephritis | 7 (28.0%) | 44 (25.3%) | 0.771 |
Pneumonia/respiratory infections | 1 (4.0%) | 35 (20.1%) | 0.050 |
Cellulitis/other skin infections | 2 (8.0%) | 28 (16.1%) | 0.290 |
Spontaneous bacterial peritonitis | 9 (36.0%) | 18 (10.3%) | <0.05 |
Bacteremia | 3 (12%) | 19 (10.9%) | 0.872 |
Colitis/enteritis | 0 (0.0%) | 12 (6.9%) | 0.176 |
Clostridium difficile | 2 (8.0%) | 7 (4.0%) | 0.371 |
Gallbladder infections | 0 (0.0%) | 7 (4.0%) | 0.307 |
Other | 2 (8.0%) | 11 (6.3%) | 0.751 |
Mechanical ventilation requirement | 13 (25%) | 64 (13.4%) | <0.05 |
Hemodialysis requirements | 7 (13.5%) | 10 (2.1%) | <0.05 |
Hospital length of stay | 11.2 (7.6) | 9.9 (8.8) | 0.330 |
Death | 21 (40.4%) | 38 (8.0%) | <0.05 |
Variable | Bivariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
Crude OR (CI) | p-Value | Adjusted OR (CI) | p-Value | |
Alcoholic cirrhosis | 2.0 (1.1–3.6) | <0.05 | 1.2 (0.5–2.4) | 0.678 |
History of ascites | 5.7 (2.9–10.9) | <0.05 | 5.8 (2.6–13.0) | <0.05 |
History of hepatic encephalopathy | 3.3 (1.8–6.0) | <0.05 | 1.5 (0.7–3.1) | 0.256 |
Hb < 11 g/dL | 2.6 (1.4–5.0) | <0.05 | 1.7 (0.8–3.7) | 0.160 |
Platelets < 150 (×103) | 2.4 (1.3–4.4) | <0.05 | 1.5 (0.7–3.2) | 0.308 |
Sodium < 135 meq/L | 3.1 (1.7–5.8) | <0.05 | 2.2 (0.9–4.7) | 0.053 |
Cr > 2.5 mg/dL | 3.0 (1.7–5.6) | <0.05 | 2.5 (1.2–5.5) | <0.05 |
Albumin < 2 g/dL | 3.8 (1.5–9.5–8.0) | <0.05 | 3.9 (1.1–13.5) | <0.05 |
Bilirubin > 2 mg/dL | 9.5 (5.1–17.7) | <0.05 | 7.9 (3.7–17.0) | <0.05 |
INR > 1.5 | 5.6 (2.9–11.1) | <0.05 | 1.4 (0.3–5.8) | 0.630 |
Spontaneous bacterial peritonitis | 4.9 (1.9–12.7) | <0.05 | 5.5 (1.4–12.2) | <0.05 |
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Sasso, R.; Abou Yassine, A.; Deeb, L. Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury. J. Clin. Med. 2021, 10, 5621. https://doi.org/10.3390/jcm10235621
Sasso R, Abou Yassine A, Deeb L. Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury. Journal of Clinical Medicine. 2021; 10(23):5621. https://doi.org/10.3390/jcm10235621
Chicago/Turabian StyleSasso, Roula, Ahmad Abou Yassine, and Liliane Deeb. 2021. "Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury" Journal of Clinical Medicine 10, no. 23: 5621. https://doi.org/10.3390/jcm10235621
APA StyleSasso, R., Abou Yassine, A., & Deeb, L. (2021). Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury. Journal of Clinical Medicine, 10(23), 5621. https://doi.org/10.3390/jcm10235621