Incidence, Mortality and Predictors of Acute Kidney Injury in Patients with Cirrhosis:A Systematic Review and Meta-analysis

摘要

Background and Aims:Acute kidney injury(AKI)is com-mon in patients with cirrhosis but the incidence is heteroge-neous among studies.We performed a meta-analysis to describe the incidence of AKI and its impact on patient mor-tality in patients with cirrhosis.We also evaluated the admis-sion variables predicting development of AKI.Methods:A systematic search of various databases was performed up to November 2018.Meta-analyses were performed using ran-dom effects models.Results:Of 18,474 patients with cirrho-sis from 30 selected studies,5,648 developed AKI,with a pooled incidence of 29%(95% confidence interval[CI]:28-30%,I2 of 99%).In-hospital mortality assessed in eight stud-ies was six-fold higher among AKI patients,as compared to those without AKI(odds ratio[OR]6.72,95%CI:3.47-13,p<0.0001,I2 of 70%).Three studies on patients admitted to intensive care showed about six-fold higher mortality among AKI patients(OR 5.90,95%CI:3.21-10.85,p>0.0001).Mor-tality remained significantly high,at days 30 and 90 and even at 1-year follow up after development of AKI.Of 12 admission variables analyzed,model for end-stage liver disease score,Child-Pugh-Turcotte stage C,presence of ascites,and pres-ence of sepsis/septic shock were statistically significant risk factors for AKI.Conclusions:AKI occurred in about 29% of patients with cirrhosis and is associated with a six-fold in-creased risk of in-hospital mortality.Mortality remained high even in long-term follow-up of 1 year.Patients at risk for AKI development can be recognized at admission.Prospective studies are needed to develop strategies for improving out-come of these patients.