Acute kidney injury in hepatitis B-related acute-on-chronic liver failure without preexisting liver cirrhosis

Acute kidney injury (AKI), as defined by the Acute Kidney Injury Network, has been widely investigated in decompensated liver cirrhosis patients. AKI is frequently progressive and independently associated with mortality in these patients. However, in the Asia-Pacific region, the majority of cases of acute-on-chronic liver failure (ACLF) are caused by acute exacerbation of chronic hepatitis B without preexisting cirrhosis. It is not clear whether these patients are at similar risk as those with underlying cirrhosis. We performed a retrospective cohort analysis of hepatitis B-related ACLF patients in a single center from January 2004 through December 2011 and evaluated the occurrence of AKI after admission and its relation to the 3-month mortality of ACLF patients. A total of 439 patients with hepatitis B-related ACLF without preexisting cirrhosis were enrolled, and 158 patients (36.0 %) developed AKI during hospitalization. ACLF patients with AKI had higher serum creatinine, bilirubin, and INR values and MELD scores as well as more complications compared to those without AKI (p < 0.01). The occurrence of AKI and its stage affect the 3-month mortality of ACLF patients (p < 0.001), and a greater percentage of AKI was found in non-survivors than survivors (56.7 vs. 27.6 %, p < 0.001). The cumulative survival of patient with no AKI, AKI stage 1, 2 and 3 was 77.84, 65.46, 41.38 and 27.03 %, respectively. In our study, we observed that AKI was associated with increased 3-month mortality in hepatitis B-related ACLF patients without preexisting cirrhosis. Higher AKI stage predicted a worse prognosis. Our findings support the importance of early identification and timely therapy of AKI in hepatitis B-related ACLF patients.