Gender-Specific Differences in Baseline, Peak, and Delta Serum Creatinine: The NACSELD Experience

Dig Dis Sci. 2017 Mar;62(3):768-776. doi: 10.1007/s10620-016-4416-7. Epub 2016 Dec 26.


Background: Women have lower serum creatinine values than men for similar renal function.

Aims: We aimed to determine the differential effect of baseline, peak, and delta creatinine between genders on outcomes in infected hospitalized cirrhotic patients.

Methods: North American Consortium for the Study of End-Stage Liver Disease is a 15-center consortium of tertiary care hepatology centers prospectively enrolling infected cirrhotic inpatients. Baseline, peak, and delta creatinine during hospitalization were compared between genders, and their impact on overall survival, transplant-free survival, probability of transplantation, and need for renal replacement therapy (RRT) was analyzed.

Results: In total, 532 patients with cirrhosis (males = 59% median admission MELD = 20) had significantly lower median baseline (1.07 vs. 1.30 mg/dL, p < 0.0001) and peak creatinine (1.47 vs. 1.59 mg/dL, p = 0.024) in women than men during hospitalization for an infection, but both genders had similar delta creatinine levels (0.30 vs. 0.30 mg/dL, p = 0.957). Thirty-day mortality was similar between genders. RRT was not used more often in women (19 vs. 12%, p = 0.050), and women were 1.8 times more likely than men to receive RRT at the same creatinine (p = 0.028). Both peak and delta creatinine significantly predicted 6-month overall and transplant-free survival (p < 0.0001), but the probability of liver transplantation was affected by the interaction between gender and both peak and delta creatinine.

Conclusions: Infected hospitalized cirrhotic women are significantly more likely than men to receive RRT at similar creatinine levels. Gender-specific differences in baseline, peak, and delta creatinine need further investigation to determine whether women need acute kidney injury treatment at lower creatinine thresholds than men.

Keywords: Acute kidney injury; Female; Gender; Liver transplant; Renal function.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Acute Kidney Injury* / blood
  • Acute Kidney Injury* / etiology
  • Acute Kidney Injury* / mortality
  • Creatinine* / analysis
  • Creatinine* / blood
  • End Stage Liver Disease* / blood
  • End Stage Liver Disease* / complications
  • End Stage Liver Disease* / etiology
  • End Stage Liver Disease* / surgery
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Infections* / complications
  • Infections* / therapy
  • Kidney Function Tests / methods
  • Liver Cirrhosis* / blood
  • Liver Cirrhosis* / complications
  • Liver Transplantation / methods
  • Male
  • Middle Aged
  • Patient Selection
  • Prospective Studies
  • Renal Replacement Therapy* / methods
  • Renal Replacement Therapy* / statistics & numerical data
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Survival Analysis
  • United States / epidemiology


  • Creatinine