Predictors of Mortality at 28-days in Infection associated Acute Kidney Injury in Cirrhosis

BACKGROUND Acute kidney injury(AKI) in cirrhosis is important complication with poor outcomes. And infections are common cause for acute decompensation. Infections in cirrhosis lead to acute deterioration of hemodynamics leading to precipitation of AKI.AIM To study predictors of mortality in patients with infection-associated AKI in cirrhosis.METHODS This was a prospective, observational study conducted at Tertiary care centre from January 2018 till April 2019. Total 119 participants with cirrhosis of liver presenting with AKI were included into the study. AKI was defined as per international club of Ascites-AKI criteria 2015. Patients were grouped into infection AKI and non-infection AKI. Non-infection AKI included patients with diuretic induced AKI and pre-renal AKI. Logistic regression analysis was used to determine predictors of mortality at 28-d.RESULTS Out of 119 patients, alcohol(n = 104) was most common etiology of cirrhosis. The infection AKI included 67(56%) patients and non-infection AKI(n = 52) included pre-renal AKI in 36(30%) and diuretic-induced AKI in 16(14%) patients. Infection AKI had significantly higher bilirubin, higher international normalized ratio(INR), low serum sodium, higher total leukocyte count(TLC) and higher prevalence of hepatic encephalopathy(HE) as compared to non-infection AKI. Infection AKI had higher progression of AKI(19/67 vs 2/52; P = 0.01) and 28-d mortality(38/67 vs 4/5; P ≤ 0.01) as compared to non-infection AKI. At 28-d, non-survivors(n = 42) had significantly higher bilirubin, higher INR, low serum sodium, higher TLC and higher prevalence of HE as compared to survivors(n = 77). On subgroup analysis of Infection AKI group, on multivariate analysis, serum bilirubin as well as presence of HE were independent predictors of 28-d mortality. There was no significant difference of mortality at 90-d between two groups.CONCLUSION Infection AKI in cirrhosis has a dismal prognosis with higher 28-d mortality as compared to non-infection AKI. Serum bilirubin and presence of HE predict 28-d mortality in infection AKI.