Analysis of the high incidence of acute kidney injury associated with acute-on-chronic liver failure.

BACKGROUND: To investigate the incidence, risk, and prognostic factors of acute kidney injury (AKI) in acute-on-chronic liver failure (ACLF) patients.

METHODS: A total of 188 patients were prospectively included and divided into AKI and non-AKI groups. Patients were followed at 1, 3, 7, 14, 28, 60, and 90 days after the onset of AKI. Significant risk factors were screened by univariate and Cox multivariate survival analyses to confirm the independent risk factors for 30- or 90-day mortality and the 90-day renal function recovery rate.

RESULTS: A total of 98 AKI cases (52.1%, [95% CI 44.9-59.3%]) occurred and the risk factors for AKI development in ACLF patients were age > 50 years (p = 0.009) and albumin (Alb) levels < 32 g/L (p = 0.007). The 30- and 90-day mortalities were significantly higher in the AKI than in the non-AKI group (79.6 vs 41.1%, 82.7 vs 56.7%, p < 0.05). AKI highest staging occurring within < 4 days of its onset and spontaneous peritonitis as well as MELD scores > 27 were independent risk factors for 30- and 90-day mortalities of ACLF AKI patients. AKI stage 3 and age > 52 years were independent risk factors for non-renal function recovery in ACLF patients with AKI.

CONCLUSIONS: ACLF patients had a high incidence of AKI, which correlated with 30- and 90-day mortalities.