title: Gender-Specific Differences in Baseline, Peak, and Delta Serum Creatinine: The NACSELD Experience.
abstract: Women have lower serum creatinine values than men for similar renal function.
  
  
  
  We aimed to determine the differential effect of baseline, peak, and delta creatinine between genders on outcomes in infected hospitalized cirrhotic patients.
  
  
  
  North American Consortium for the Study of End-Stage Liver Disease is a 15-center consortium of tertiary care hepatology centers prospectively enrolling infected cirrhotic inpatients. Baseline, peak, and delta creatinine during hospitalization were compared between genders, and their impact on overall survival, transplant-free survival, probability of transplantation, and need for renal replacement therapy (RRT) was analyzed.
  
  
  
  In total, 532 patients with cirrhosis (males = 59% median admission MELD = 20) had significantly lower median baseline (1.07 vs. 1.30 mg/dL, p < 0.0001) and peak creatinine (1.47 vs. 1.59 mg/dL, p = 0.024) in women than men during hospitalization for an infection, but both genders had similar delta creatinine levels (0.30 vs. 0.30 mg/dL, p = 0.957). Thirty-day mortality was similar between genders. RRT was not used more often in women (19 vs. 12%, p = 0.050), and women were 1.8 times more likely than men to receive RRT at the same creatinine (p = 0.028). Both peak and delta creatinine significantly predicted 6-month overall and transplant-free survival (p < 0.0001), but the probability of liver transplantation was affected by the interaction between gender and both peak and delta creatinine.
  
  
  
  Infected hospitalized cirrhotic women are significantly more likely than men to receive RRT at similar creatinine levels. Gender-specific differences in baseline, peak, and delta creatinine need further investigation to determine whether women need acute kidney injury treatment at lower creatinine thresholds than men.
authors.affiliation: Division of Hepatology, Baylor Simmons Transplant Institute, Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, 3410 Worth St, Suite 860, Dallas, TX, 75246, USA. dr_jackieo@yahoo.com.
authors.forename: Jacqueline G
authors.initials: JG
authors.lastname: O'Leary
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Florence
authors.initials: F
authors.lastname: Wong
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.affiliation: Department of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: Department of Medicine, University of Colorado Denver, Denver, CO, USA.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
authors.affiliation: Department of Medicine, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Fallon
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Ram M
authors.initials: RM
authors.lastname: Subramanian
authors.affiliation: Department of Medicine, University of Rochester, Rochester, NY, USA.
authors.forename: B
authors.initials: B
authors.lastname: Maliakkal
authors.affiliation: Department of Medicine, Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Leroy
authors.initials: L
authors.lastname: Thacker
authors.affiliation: Department of Medicine, Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.|McGuire VA Medical Center, Richmond, VA, USA.
authors.forename: Jasmohan S
authors.initials: JS
authors.lastname: Bajaj
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000401:mortality; D003404:Creatinine / Q000032:analysis / Q000097:blood; D058625:End Stage Liver Disease / Q000097:blood / Q000150:complications / Q000209:etiology / Q000601:surgery; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007239:Infections / Q000150:complications / Q000628:therapy; D007677:Kidney Function Tests / Q000379:methods; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D003404:Creatinine
keywords: Acute kidney injury; Female; Gender; Liver transplant; Renal function