title: Acute kidney injury and acute-on-chronic liver failure classifications in prognosis assessment of patients with acute decompensation of cirrhosis.
abstract: OBJECTIVE
  Prognostic stratification of patients with cirrhosis is common clinical practice. This study compares the prognostic accuracy (28-day and 90-day transplant-free mortality) of the acute-on-chronic liver failure (ACLF) classification (no ACLF, ACLF grades 1, 2 and 3) with that of acute kidney injury (AKI) classification (no AKI, AKI stages 1, 2 and 3).
  
  
  METHODS
  The study was performed in 510 patients with an acute decompensation of cirrhosis previously included in the European Association for the Study of the Liver-Chronic Liver Failure consortium CANONIC study. ACLF was evaluated at enrollment and 48 h after enrollment, and AKI was evaluated at 48 h according to Acute Kidney Injury Network criteria.
  
  
  RESULTS
  240 patients (47.1%) met the criteria of ACLF at enrollment, while 98 patients (19.2%) developed AKI. The presence of ACLF and AKI was strongly associated with mortality. 28-day transplant-free mortality and 90-day transplant-free mortality of patients with ACLF (32% and 49.8%, respectively) were significantly higher with respect to those of patients without ACLF (6.2% and 16.4%, respectively; both p<0.001). Corresponding values in patients with and without AKI were 46% and 59%, and 12% and 25.6%, respectively (p<0.0001 for both). ACLF classification was more accurate than AKI classification in predicting 90-day mortality (area under the receiving operating characteristic curve=0.72 vs 0.62; p<0.0001) in the whole series of patients. Moreover, assessment of ACLF classification at 48 h had significantly better prognostic accuracy compared with that of both AKI classification and ACLF classification at enrollment.
  
  
  CONCLUSIONS
  ACLF stratification is more accurate than AKI stratification in the prediction of short-term mortality in patients with acute decompensation of cirrhosis.
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy Unit of Hepatic Emergencies and Liver Transplantation, Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.affiliation: Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Fundación Renal Iñigo Alvarez de Toledo, (FRIAT), Madrid, Spain.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Rodríguez
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy Unit of Hepatic Emergencies and Liver Transplantation, Padova, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piano
authors.affiliation: Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Fundación Renal Iñigo Alvarez de Toledo, (FRIAT), Madrid, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Ariza
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy Unit of Hepatic Emergencies and Liver Transplantation, Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Morando
authors.affiliation: Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Fundación Renal Iñigo Alvarez de Toledo, (FRIAT), Madrid, Spain Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Elsa
authors.initials: E
authors.lastname: Solà
authors.affiliation: Department of Medicine (DIMED), University of Padova, Italy Unit of Hepatic Emergencies and Liver Transplantation, Padova, Italy.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Romano
authors.affiliation: Data Management Centre, CLIF Consortium, Barcelona, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: García
authors.affiliation: Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain Data Management Centre, CLIF Consortium, Barcelona, Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Pavesi
authors.affiliation: Hospital San Giovanni Battista Hospital, University of Torino, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Risso
authors.affiliation: Liver Unit, Klinikum Munich, Lugwig Maximilian University of Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gerbes
authors.affiliation: Intensive Care Unit, Hepatology Department, Kings College London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Willars
authors.affiliation: Semeiotica Medica-Policlinico S. Orsola-Malpighi, University of Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
authors.affiliation: Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.affiliation: Liver Unit, Hospital Clinic de Barcelona, University of Barcelona, Spain Institut d'Investigacions Biomediques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain Fundación Renal Iñigo Alvarez de Toledo, (FRIAT), Madrid, Spain Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D058186:Acute Kidney Injury / Q000145:classification* / Q000453:epidemiology / Q000209:etiology; D065290:Acute-On-Chronic Liver Failure / Q000145:classification* / Q000150:complications / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D017114:Liver Failure, Acute / Q000145:classification* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012372:ROC Curve; D015996:Survival Rate / Q000639:trends
keywords: ACUTE LIVER FAILURE; CIRRHOSIS; LIVER