title: Relevance of New Definitions to Incidence and Prognosis of Acute Kidney Injury in Hospitalized Patients with Cirrhosis: A Retrospective Population-Based Cohort Study.
abstract: BACKGROUND
  The implementation of new serum creatinine (SCr)-based criteria for acute kidney injury (AKI) has brought to light several areas of uncertainty in patients with cirrhosis.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Adults with cirrhosis hospitalized between 2002-2012.
  
  
  METHODS
  We aimed to address the prognostic implications of the new AKI criteria in cirrhosis.
  
  
  RESULTS
  Baseline kidney function was defined from all outpatient SCr within 3 months before hospitalization. Cox proportional hazards models were fit to examine associations between AKI, renal recovery and all-cause mortality.
  
  
  RESULTS
  4,733 patients were studied. The 30-day mortality was higher for participants with AKI (43.9% vs 8.5%; p-value<0.001), and increased with AKI severity. The highest incidence of AKI occurred when the lowest SCr within the three months prior to admission was used to define baseline. The hazard ratio for mortality using the lowest SCr within 3 months and the closest pre-admission SCr (definition suggested by the recent consensus guideline) were similar, validating the use of the latter measure. As compared to patients without AKI, stage 1 AKI with maximum SCr ≤132 mmol/L remained associated with a 3.5-fold increased hazard of death at 30 days (95% CI 2.6 to 4.7).
  
  
  CONCLUSIONS
  As an observational study, the results were vulnerable to residual confounding and ascertainment bias in the use of laboratory data to identify AKI. We did not have access to liver function or disease etiology variables and were unable to adjust for these in our analyses.
  
  
  CONCLUSIONS
  These results confirm the graded relationship between AKI severity, renal recovery, and mortality and further clarify previously discordant reports about the prognostic relevance of new AKI criteria in patients with cirrhosis.
authors: Cirrhosis Care Clinic, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.|CEGIIR, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Puneeta
authors: P
authors: Tandon
authors: Division of Nephrology, University of Calgary, Calgary, Alberta, Canada.
authors: Matthew T
authors: MT
authors: James
authors: Cirrhosis Care Clinic, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.|CEGIIR, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Juan G
authors: JG
authors: Abraldes
authors: Cirrhosis Care Clinic, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.|CEGIIR, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.|Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Constantine J
authors: CJ
authors: Karvellas
authors: Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
authors: Feng
authors: F
authors: Ye
authors: Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
authors: Neesh
authors: N
authors: Pannu
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005355:Fibrosis / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies