Early echocardiographic signs of diastolic dysfunction predict acute kidney injury in cirrhotic patients
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Published on: March 11, 2016
Pei-Shan Wu1,2, Ying-Wen Wang2,3, Cheng-Chun Tai2
1Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Insights
Cirrhotic patients’ survival is impacted by cardiovascular dysfunction. While liver disease severity predicts mortality, echocardiography may help predict acute kidney injury (AKI) in select patients.
Area of Science:
- Cardiology
- Hepatology
- Nephrology
Background:
- Cardiovascular dysfunction is a significant factor affecting survival and complications in cirrhotic patients.
- Predicting mortality and acute kidney injury (AKI) in this population is crucial for improving outcomes.
Purpose of the Study:
- To evaluate echocardiographic parameters for predicting 1-year mortality and AKI in cirrhotic patients.
- To identify early indicators of cardiac dysfunction that correlate with adverse events.
Main Methods:
- Retrospective analysis of 103 cirrhotic patients who underwent echocardiography.
- Transthoracic two-dimensional echocardiography with tissue Doppler imaging was used to assess cardiac function.
- Cox hazard regression analysis identified predictors for 1-year mortality and AKI.
Main Results:
- Child-Pugh score was the sole predictor of 1-year mortality.
- Higher baseline serum creatinine, total bilirubin, and E/e' ratio predicted AKI.
- In patients with serum creatinine < 1.5 mg/dL, increased atrial filling velocity and higher albumin-bilirubin (ALBI) scores predicted AKI.
Conclusions:
- Liver disease severity, not echocardiography, predicts 1-year mortality in cirrhosis.
- Early echocardiographic signs of diastolic dysfunction and elevated ALBI scores may predict AKI in cirrhotic patients with preserved renal function (serum creatinine < 1.5 mg/dL).
Background:
Cardiovascular dysfunction in cirrhotic patients affects survival and the development of cirrhotic complications. We aimed to evaluate potential echocardiographic parameters to predict mortality and acute kidney injury (AKI) in cirrhotic patients.
Methods:
A total of 103 cirrhotic patients who underwent echocardiography between February 2009 and August 2016 in Taipei Veterans General Hospital were retrospectively enrolled. Cardiac function was evaluated using transthoracic two-dimensional echocardiography with tissue Doppler imaging. Cox hazard regression analysis was used for assessing predictors for 1-year mortality and AKI within 1 year.
Results:
Baseline echocardiographic parameters were similar between survivors (n = 92) and nonsurvivors (n = 11). Lower serum levels of albumin, as well as higher albumin-bilirubin (ALBI) scores, Child-Pugh scores, and model for end-stage liver disease scores were observed in nonsurvivors. Cox proportional hazard regression analysis revealed Child-Pugh score as the only predictor of 1-year mortality. Baseline serum creatinine (Cr) > 1.5 mg/dL, total bilirubin > 2 mg/dL, and a higher E/e' ratio predict occurrence of AKI within 1 year. Among patients with serum Cr < 1.5 mg/dL, an increased atrial filling velocity and higher ALBI scores predict AKI occurrence within 1 year.
Conclusion:
Severity of underlying liver disease but not echocardiographic parameters predicts 1-year mortality in cirrhosis. Early echocardiographic signs of diastolic dysfunction and higher ALBI scores may predict development of AKI in cirrhotic patients with serum Cr < 1.5 mg/dL.
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