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

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.

Ethical statement: The research was conducted in accordance with the Helsinki statement of the World Assembly 2013.

Declaration of interests: None.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Figure 1

Figure 2