Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease
Background and Aim Acute kidney injury (AKI) commonly occurs in patients with chronic liver disease (CLD). As per the International Club of Ascites, AKI is classified into three stages; stage 1 has recently been divided into subgroups 1A and 1B. We performed a prospective study to validate the assoc...
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| Format: | Article |
| Language: | English |
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Wiley
2019-08-01
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| Series: | JGH Open |
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| Online Access: | https://doi.org/10.1002/jgh3.12152 |
| _version_ | 1818603544943525888 |
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| author | Chitta R Khatua Saroj K Sahu Rakesh K Barik Subhasis Pradhan Subhendu Panigrahi Debakanta Mishra Shivaram P Singh |
| author_facet | Chitta R Khatua Saroj K Sahu Rakesh K Barik Subhasis Pradhan Subhendu Panigrahi Debakanta Mishra Shivaram P Singh |
| author_sort | Chitta R Khatua |
| collection | DOAJ |
| description | Background and Aim Acute kidney injury (AKI) commonly occurs in patients with chronic liver disease (CLD). As per the International Club of Ascites, AKI is classified into three stages; stage 1 has recently been divided into subgroups 1A and 1B. We performed a prospective study to validate the association between subgrouping and outcome. Methods This study was conducted using decompensated cirrhosis (DC) patients hospitalized in the Gastroenterology ward between August 2016 and May 2018. Demographic, clinical, and laboratory parameters were compared between AKI 1A and AKI 1B patients. The duration of hospitalization and outcome were compared. Results A total of 528 subjects were enrolled; 296 (56.1%) had AKI, and of them, 61.48% (n = 182) had stage 1, 20.95% (n = 62) had stage 2, and 17.57% (n = 52) had stage 3 AKI. Of the enrolled patients, 100 (54.94%) had early (AKI 1A) and 82 (45.06%) had late stage 1 AKI (AKI 1B). Patients with AKI 1B had higher total leucocyte count, total bilirubin, serum urea, serum creatinine (SCr), model for end‐stage liver disease (MELD), MELD‐Na+, and child‐turcotte‐pugh (CTP) score and decreased serum albumin than AKI 1A. The prevalence of hepatorenal syndrome (HRS), acute on chronic liver failure (ACLF) were higher in AKI 1B patients, and they had a prolonged hospital stay compared to AKI 1A patients. Furthermore, AKI 1B patients had significantly lower survival both at 28 days and 90 days. Conclusion Our study validates the subclassification of stage 1 AKI. Patients with AKI 1B more often progress to higher AKI stages with significantly lower 28‐day and 90‐day survival rates. Results justify subclassification and suggest the need for early intervention. The small increase in SCr should be viewed with caution in AKI stage 1A. |
| first_indexed | 2024-12-16T13:24:52Z |
| format | Article |
| id | doaj.art-f76ea357f19a4b0f80471f8a14a06dc7 |
| institution | Directory Open Access Journal |
| issn | 2397-9070 |
| language | English |
| last_indexed | 2024-12-16T13:24:52Z |
| publishDate | 2019-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | JGH Open |
| spelling | doaj.art-f76ea357f19a4b0f80471f8a14a06dc72022-12-21T22:30:15ZengWileyJGH Open2397-90702019-08-013429029410.1002/jgh3.12152Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver diseaseChitta R Khatua0Saroj K Sahu1Rakesh K Barik2Subhasis Pradhan3Subhendu Panigrahi4Debakanta Mishra5Shivaram P Singh6Department of Gastroenterology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack 753007 Odisha IndiaDepartment of Gastroenterology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack 753007 Odisha IndiaDepartment of Gastroenterology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack 753007 Odisha IndiaDepartment of Gastroenterology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack 753007 Odisha IndiaDepartment of Gastroenterology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack 753007 Odisha IndiaDepartment of Gastroenterology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack 753007 Odisha IndiaDepartment of Gastroenterology, Sriram Chandra Bhanja Medical College and Hospital, Cuttack 753007 Odisha IndiaBackground and Aim Acute kidney injury (AKI) commonly occurs in patients with chronic liver disease (CLD). As per the International Club of Ascites, AKI is classified into three stages; stage 1 has recently been divided into subgroups 1A and 1B. We performed a prospective study to validate the association between subgrouping and outcome. Methods This study was conducted using decompensated cirrhosis (DC) patients hospitalized in the Gastroenterology ward between August 2016 and May 2018. Demographic, clinical, and laboratory parameters were compared between AKI 1A and AKI 1B patients. The duration of hospitalization and outcome were compared. Results A total of 528 subjects were enrolled; 296 (56.1%) had AKI, and of them, 61.48% (n = 182) had stage 1, 20.95% (n = 62) had stage 2, and 17.57% (n = 52) had stage 3 AKI. Of the enrolled patients, 100 (54.94%) had early (AKI 1A) and 82 (45.06%) had late stage 1 AKI (AKI 1B). Patients with AKI 1B had higher total leucocyte count, total bilirubin, serum urea, serum creatinine (SCr), model for end‐stage liver disease (MELD), MELD‐Na+, and child‐turcotte‐pugh (CTP) score and decreased serum albumin than AKI 1A. The prevalence of hepatorenal syndrome (HRS), acute on chronic liver failure (ACLF) were higher in AKI 1B patients, and they had a prolonged hospital stay compared to AKI 1A patients. Furthermore, AKI 1B patients had significantly lower survival both at 28 days and 90 days. Conclusion Our study validates the subclassification of stage 1 AKI. Patients with AKI 1B more often progress to higher AKI stages with significantly lower 28‐day and 90‐day survival rates. Results justify subclassification and suggest the need for early intervention. The small increase in SCr should be viewed with caution in AKI stage 1A.https://doi.org/10.1002/jgh3.12152acute kidney injurychronic liver diseaseserum creatinine |
| spellingShingle | Chitta R Khatua Saroj K Sahu Rakesh K Barik Subhasis Pradhan Subhendu Panigrahi Debakanta Mishra Shivaram P Singh Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease JGH Open acute kidney injury chronic liver disease serum creatinine |
| title | Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease |
| title_full | Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease |
| title_fullStr | Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease |
| title_full_unstemmed | Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease |
| title_short | Validation of International Club of Ascites subclassification of stage 1 acute kidney injury in chronic liver disease |
| title_sort | validation of international club of ascites subclassification of stage 1 acute kidney injury in chronic liver disease |
| topic | acute kidney injury chronic liver disease serum creatinine |
| url | https://doi.org/10.1002/jgh3.12152 |
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