Prognostic Significance of Acute Kidney Injury Subtype among Patients with Decompensated Cirrhosis: A 10-Year...

Acute kidney injury (AKI) is a frequent, life-threatening complication of decompensated cirrhosis. Among patients with cirrhosis, AKI encompasses several subtypes: prerenal azotemia (PRA), acute tubular necrosis (ATN), bile pigment nephropathy (BPN), abdominal compartment syndrome (ACS), and hepatorenal syndrome-associated AKI (HRS-AKI). Despite extensive research into the relationship between AKI severity and mortality, a gap persists in understanding the prognostic significance of AKI types for major adverse kidney events (MAKE) among these patients. Our study aimed to determine whether AKI subtypes serve as prognostic indicators for the development of MAKE.

We conducted a retrospective study over a 10-year period. Patients were categorized based on AKI type, and MAKE occurrences were analyzed.

The study cohort comprised 104 patients. Of these, 51.9% presented with PRA, 19.2% with HRS-AKI, 12.5% with ATN, 12.5% with ACS, and 3.8% with BPN. The primary composite outcome of MAKE was observed in 34% of patients. PRA demonstrated a protective effect against MAKE (OR 0.20, 95% CI: 0.08-0.49, p <0.001) and its outcomes. In contrast, ATN was associated with an increased risk of MAKE (OR 5.94, 95% CI: 1.64-21.03, p = 0.003) and the need for kidney replacement therapy (OR 6.23, 95% CI: 1.76-21.96, p = 0.002).

AKI in patients with decompensated cirrhosis significantly increases the risk of complications. Our findings underscore the value of AKI subtype as a prognostic marker for MAKE in this population. Notably, PRA is associated with better outcomes, whereas ATN poses a higher risk of MAKE, compared with other forms of AKI.