title: Acute kidney injury is an early predictor of mortality for patients with alcoholic hepatitis.
abstract: OBJECTIVE
  Alcoholic hepatitis (AH) is a severe condition with high mortality. To improve therapeutic strategies, it is important to identify factors that affect survival times. The age, bilirubin, international normalized ratio, and creatinine scoring system (also known as the ABIC scoring system) was developed previously to determine the prognosis of patients with AH. We studied effects of acute kidney injury (AKI) on survival of patients with AH.
  
  
  METHODS
  We retrospectively analyzed data from 103 patients with biopsy-proven AH. AKI was defined as an abrupt reduction (within 48 h) in kidney function that resulted in an absolute increase of at least 0.3 mg/dL (or a 50% increase) in serum levels of creatinine from baseline (the AKI network [AKIN] criteria).
  
  
  RESULTS
  Twenty-nine patients (28%) developed AKI during hospitalization, with a median time to diagnosis of 3 days. Overall 90-day mortality was 23%, which was significantly higher among patients with AKI than those without (65% vs 7%; P < .0001). The age, bilirubin, international normalized ratio, and creatinine score (P < .0001) and development of AKI (P < .0001) were the most accurate independent predictors of 90-day mortality. The presence of systemic inflammatory response syndrome (P < .0001), serum bilirubin (P = .01), and international normalized ratio at admission (P = .03) were the most accurate predictors of AKI. Importantly, the AKIN criteria were more accurate than traditional criteria for renal failure (serum creatinine >1.5 mg/dL) in predicting 90-day mortality (area under the receiver operating characteristic, 0.83 vs 0.70, respectively; P = .02).
  
  
  CONCLUSIONS
  Development of AKI reduces survival of patients with AH, in the short term. The AKIN criteria are useful and more accurate than traditional criteria in predicting mortality. Strategies to prevent AKI therefore should be considered in the management of patients with AH.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Altamirano
authors.forename: Claudia
authors.initials: C
authors.lastname: Fagundes
authors.forename: Marlene
authors.initials: M
authors.lastname: Dominguez
authors.forename: Elisabet
authors.initials: E
authors.lastname: García
authors.forename: Javier
authors.initials: J
authors.lastname: Michelena
authors.forename: Andrés
authors.initials: A
authors.lastname: Cárdenas
authors.forename: Monica
authors.initials: M
authors.lastname: Guevara
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pereira
authors.forename: Karina
authors.initials: K
authors.lastname: Torres-Vigil
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.forename: Juan
authors.initials: J
authors.lastname: Caballería
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
authors.forename: Ramón
authors.initials: R
authors.lastname: Bataller
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis*; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D005260:Female; D006519:Hepatitis, Alcoholic / Q000150:complications* / Q000401:mortality*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D003404:Creatinine