Acute Kidney Injury in Patients with Cirrhosis Increases Healthcare Burden

Patients with cirrhosis and acute kidney injury have longer hospital stays and higher mortality rates.

Patients with cirrhosis and acute kidney injury (AKI) have longer hospital stays and higher mortality rates, according to results from a population-based study published in the Journal of Hepatology.

Researchers gathered information from the National Inpatient Sample (NIS) database including data from 3.6 million patients with cirrhosis with and without AKI. AKI was identified by the International Classification of Diseases (9th and 10th revision) Clinical Modification codes.

Of all patients with cirrhosis, 22% had AKI. The patients with AKI received more costly care at the hospital (median $13,127; interquartile range [IQR], $7367-$24,891 vs $8,079; IQR, $4956-$13,693) and had a longer duration of stay at the hospital (median 6 days; IQR, 3-11 vs 4 days; IQR, 2-7) compared with those without AKI. Chronic kidney disease was independently associated with AKI in patients with cirrhosis with an adjusted odd’s ratio (AOR) of 3.75 (95% CI, 3.72-3.77).

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Hospital stays for patients with AKI were more likely to result in death, with an AOR of 3.75 (95% CI, 3.71-3.79). Pneumonia (16.9% vs 7.8%; P <.001), sepsis (43.8% vs 13.5%; P <.001), and required mechanical ventilation (59.0% vs 10.2%; P <.001) were more likely to be identified in patients with AKI who died compared with patients without AKI. The researchers also observed that the rate of AKI has been increasing over time in the United States, from a rate of 15% in 2004 to 30% in 2016.

One limitation of the study is that patient data spanned the 9th and 10th revision of diagnostic codes. These code definitions may have introduced variation in the analysis.

The study authors concluded that AKI in patients with cirrhosis substantially increases burden on the healthcare system and leads to overall poorer clinical outcomes.

Disclosures: Some authors declared receiving consulting or funding from the pharmaceutical industry. A complete list of disclosures can be found in the original study.

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Desai A P, Knapp S M, Orman E S, et al. Changing epidemiology and outcomes of acute kidney injury in hospitalized patients with cirrhosis – a US population-based study [available online May 6, 2020]. J Hepatol. doi:10.1016/j.jhep.2020.04.043