Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites.

BACKGROUND AND AIMS: For several years hepatologists have defined acute renal failure in patients with cirrhosis as an increase in serum creatinine (sCr) ⩾ 50% to a final value of sCr > 1.5 mg/dl (conventional criterion). Recently, the Acute Kidney Injury Network (AKIN) defined acute renal failure as acute kidney injury (AKI) on the basis of an absolute increase in sCr of 0.3 mg/dL or a percentage increase in sCr⩾ 50% providing also a staging from 1 to 3. AKIN stage 1 was defined as increase in sCr ⩾ 0.3 mg/dl or an increase in sCr ⩾ 1.5-fold to 2-fold from baseline. AKI diagnosed with the two different criteria was evaluated for the prediction of in-hospital mortality METHODS: Consecutive hospitalized patients with cirrhosis and ascites were included in the study and evaluated for the development of AKI. RESULTS: Conventional criterion was found to be more accurate than AKIN criteria in improving the prediction of in-hospital mortality in a model including age and Child-Turcotte-Pugh score. The addition of either progression of AKIN stage or a threshold value for sCr of 1.5 mg/dl further improves the value of AKIN criteria in this model. More in detail, patients with AKIN stage 1 and sCr < 1.5 mg/dl had a lower mortality rate (P=0.03), a lower progression rate (P=0.01) and a higher improvement rate (P=0.025) than patients with AKIN stage 1 and sCr ⩾ 1.5 mg/dl. CONCLUSIONS: Conventional criterion is more accurate than AKIN criteria in the prediction of in-hospital mortality in patients with cirrhosis and ascites. The addition of either the progression of AKIN stage or the cut-off of sCr ⩾1.5 mg/dl, to the AKIN criteria improves their prognostic accuracy.