Evaluation of Absolute Serum Creatinine Changes in Staging of Cirrhosis-Induced Acute Renal Injury and its Association with Long-term Outcomes

• Main Authors: Fangfang Zhou, Qun Luo, Lina Han, Huadong Yan, Wenhong Zhou, Zemin Wang, Yumei Li
• Format: Article
• Language: English
• Published: Karger Publishers 2017-05-01
• Series: Kidney & Blood Pressure Research
• Subjects: Acute kidney injury; Cirrhosis; Classification; Creatinine; Mortality
• Online Access: http://www.karger.com/Article/FullText/477529
• ISSN: 1420-4096; 1423-0143

Background/Aims: To assess the prognostic accuracy of absolute serum creatinine (sCr) changes (‘Delta-sCr’) on the long-term outcomes in cirrhotic patients, and evaluate the performance of the ‘Delta-sCr’ approach to stage acute kidney injury (AKI), compared with the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Methods: We conducted a retrospective analysis of 333 hospitalized patients. We classified AKI stages using two methods: 1) KDIGO AKI criteria; 2) ‘Delta-sCr’ system, defined by the difference between the baseline and the peak sCr value during the hospitalization. The end point was the hazard of 1-year death. Results: The prevalence of AKI in cirrhotic patients was 18.01% by the KDIGO criteria, and 25.22% by the ‘Delta-sCr’ system. On multivariable Cox hazard analysis, both of the two methods were independent predictive factors of death (‘Delta-sCr’ system: OR=2.911, p<0.001), (KDIGO criteria: OR=2.065, p<0.001). However, the ‘Delta-sCr’ system provided a modest improvement in classification over the KDIGO criteria with a net reclassification improvement (NRI) of 28.7% (p<0.001) and integrated discrimination improvement (IDI) of 7.5% (p=0.03). And the predictive value of the ‘Delta-sCr’ system could be significantly improved (p=0.006), when combined with age and MELD score. Conclusion: The Delta-sCr is associated with the 1-year mortality. And the ‘Delta-sCr’ system may optimize the discrimination of risk prediction.