title: Akin criteria as a predictor of mortality in cirrhotic patients after spontaneous bacterial peritonitis.
abstract: OBJECTIVE
  Spontaneous bacterial peritonitis (SBP) often triggers acute-on-chronic liver failure (ACLF). Acute kidney injury (AKI) is frequent and correlates with higher mortality in such cases. The aim of this study is to evaluate the Acute Kidney Injury Network (AKIN) criteria in the prediction of death in cirrhotic patients after an episode of SBP.
  
  
  METHODS
  Forty-six cirrhotic patients with SBP were included in a cohort study. Renal injury was estimated by AKIN criteria (grades 1, 2 or 3) to examine the association between AKI severity and mortality. Patients were followed-up for a mean of 13.22 months. Kaplan-Meier survival curve and the hazard ratio of mortality by Cox regression model were calculated accordingly to the AKIN criteria.
  
  
  RESULTS
  The mean age of the included patients was 56.94 ± 9.49; 29 (63%) were male. Mean MELD score was 19.46 ± 6.16; 78.3% were Child-Pugh C. AKI occurred in 43.5% of patients (8.7, 17.4 and 17.4% respectively for AKIN criteria 1, 2 and 3). Inpatient mortality for AKIN 1, 2 and 3 was 50, 37.5 and 62.5 vs. 3.8% for patients without renal injury (p = 0.002, 0.001 and < 0.001 respectively). Patients with AKIN grades 1, 2 or 3 had no significant differences regarding MELD score (p = 0.893). The hazard ratio and 95% confidence interval of mortality for patients with AKI (AKIN grades 1, 2 and 3 grouped) were 3.41 (1.58-7.36).
  
  
  CONCLUSIONS
  AKIN criteria are useful to predict mortality in patients with SBP.
authors.affiliation: School of Medicine, Division of Gastroenterology, Hospital de Clínicas de Porto Alegre, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: de Araujo
authors.affiliation: School of Medicine, Division of Gastroenterology, Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Mario Reis
authors.initials: MR
authors.lastname: Alvares-da-Silva
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index