Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes

Am J Gastroenterol. 2017 Jul;112(7):1103-1110. doi: 10.1038/ajg.2017.122. Epub 2017 Apr 25.


Objectives: The International Ascites Club (IAC) recently defined Stage 1 acute kidney injury (AKI) for cirrhosis as an acute increase in serum creatinine (SCr) by ≥0.3 mg/dl or by ≥50% in <48 h from a stable value within 3 months. The baseline SCr may influence AKI risk and patient outcomes. The objective of this study is to determine in cirrhosis whether the baseline SCr has any effect on the in-hospital AKI course and patient survival.

Methods: North American Consortium for the Study of End-Stage Liver Disease is a consortium of tertiary-care hepatology centers prospectively enroling non-elective cirrhotic inpatients. Patients with different baseline SCr levels (≤0.5, 0.51-1.0, 1.01-1.5, >1.5 mg/dl) were evaluated for the development of AKI, and compared for AKI outcomes and 30-day survival.

Results: 653 hospitalized cirrhotics (56.7±10years, 64% men, 30% with infection) were included. The incidence of AKI was 47% of enrolled patients. Patients with higher baseline SCr were more likely to develop AKI, with significantly higher delta and peak SCr (P<0.001) than the other groups, more likely to have a progressive AKI course (P<0.0001), associated with a significantly reduced 30-day survival (P<0.0001). Multivariate logistic regression showed that the delta SCr during an AKI episode to be the strongest factor impacting AKI outcomes and survival (P<0.001), with a delta SCr of 0.70 mg/dl having a 68% sensitivity and 80% specificity for predicting 30-day mortality.

Conclusions: Admitted cirrhotic patients with higher baseline SCr are at higher risk for in-hospital development of AKI, and more likely to have AKI progression with reduced survival. Therefore, such patients should be closely monitored and treated promptly for their AKI.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / etiology*
  • Biomarkers / blood
  • Creatinine / blood*
  • Female
  • Humans
  • Liver Cirrhosis / blood*
  • Liver Cirrhosis / complications*
  • Male
  • Middle Aged
  • Risk Factors
  • Sensitivity and Specificity
  • Survival Rate


  • Biomarkers
  • Creatinine