title: Evaluation of acute kidney injury and its response to terlipressin in patients with acute-on-chronic liver failure.
abstract: OBJECTIVE
  Patients with acute-on-chronic liver failure (ACLF) have high mortality. Cirrhotics with acute kidney injury (AKI) have poor outcome but relevance of AKI and response to terlipressin in ACLF is not known.
  
  
  METHODS
  Consecutive ACLF patients with AKI at admission were compared with those without AKI (controls) for mortality at day 7, month 1 and 3, presence of hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP) and acute variceal bleed (AVB). Patients were also compared based on severity of AKI (mild; S.cr 1.5-3 mg/dl and marked; S.cr >3 mg/dl). Response to terlipressin was also evaluated.
  
  
  RESULTS
  Of 241 ACLF patients, 55 (22.8%) had AKI at admission. Patients with AKI had higher mortality at day 7, 1 and 3 month and more often developed HE [54.1% vs. 30.6%; P = 0.001] and SBP [9.1% vs. 5.9%; P = 0.02]. Patients with marked AKI neither had higher mortality or complications in comparison to mild AKI. Presence of AKI [Odds ratio; OR, 2.4], S.bilirubin >20 mg/dl [OR, 3.1] and INR [OR, 2.9] were independent baseline predictors of mortality. Terlipressin was used in 28 of 55 patients with AKI who were volume non-responsive (hepatorenal syndrome, AKI-HRS). Ten (35.7%) of these showed response (S.Cr < 1.5 mg/dl) [median 4 days] and had lower mortality compared to terlipressin non-responders (10% vs. 50%, P = 0.05). There was no difference in terlipressin response in mild vs. marked AKI.
  
  
  CONCLUSIONS
  Almost one-fourth of the ACLF patients have AKI at admission and presence of AKI, but not its severity predicts complications and high mortality. Terlipressin effectively reverses AKI-HRS within a week in ~35% of ACLF patients resulting in improved survival.
authors.affiliation: Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India.
authors.forename: Ankur
authors.initials: A
authors.lastname: Jindal
authors.affiliation: Department of Biostatistics and Clinical Reserch, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India.
authors.forename: Ajeet S
authors.initials: AS
authors.lastname: Bhadoria
authors.affiliation: Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Maiwall
authors.affiliation: Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India.|Special Centre for Molecular Medicine, Jawaharlal Nehru University (JNU), New Delhi, India.
authors.forename: Shiv K
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D065290:Acute-On-Chronic Liver Failure / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008236:Lypressin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin
keywords: cirrhosis; liver failure; renal dysfunction