RISK STRATIFICATION AND 90 DAYS OUTCOME OF IMPAIRMENT OF KIDNEY FUNCTION IN PATIENTS WITH CIRRHOSIS BY CAUSES AND REVISED CONSENSUS BY INTERNATIONAL CLUB OF ASCITES

Introduction: Cirrhotic patients with acute renal failure have poor survival. We aimed to examine the association between type of acute kidney injury, cause and 90-day survival. Methods: This was a prospective observational study in a tertiary centre of consecutive patients admitted with cirrhosis and renal dysfunction in a tertiary centre. They were classified according to revised consensus and by the cause of renal failure: renal failure associated with infections; hypovolemia; hepatorenal syndrome (HRS) and parenchymal nephropathy. The primary end point was survival at 90 days. Results: Total 112 patients had acute kidney injury during the study period from 1st January 2016 to 31st December 2016. Renal dysfunction associated with infection (49.1%) was most common cause followed by hypovolemia (28.7%), HRS (18.7%) and parenchymal renal diseases (3.5%). Progression of renal dysfunction was seen in HRS group (14/21, 53.8%), followed by infection (20%), hypovolemia (6%) and parenchymal renal disease (0%). Complete response to treatment was seen in hypovolemia group (18/29, 62%) followed by infection (25/50, 50%), parenchymal disease (2/4, 50%) and HRS (0%) in decreasing order. HRS was associated with high mortality at 90 days (20/21, 95%), followed by infection (56%), hypovolemia (41%) and parenchymal renal diseases (25%). Progression of renal dysfunction is independently associated with mortality. Conclusion: The results of the current study confirm that acute kidney injury, as defined by International Club of Ascites, is associated with high 90 days mortality. Similarly classification by cause of renal dysfunction can predict mortality and outcome.