Improved Mortality Risk Stratification in Decompensated Liver Cirrhosis and Acute-On-Chronic Liver Failure Using the Updated KDIGO AKI Criteria

Introduction: Acute decompensation of cirrhosis is a landmark event with relevant implications for short- and medium-term mortality. For acute-on-chronic liver failure (ACLF), CLIF definition of renal organ failure (OF) requires a creatinine value≥2,0mg/dl, regardless of etiology. However, creatinine is significantly impacted by a variety of patient-specific factors such as ethnicity or nutritional status and thus likely underestimates the degree of kidney function impairment in the cirrhotic patient.

Aims & Methods: We applied the KDIGO definition for AKI to patients with decompensated liver cirrhosis. From the LMU Klinikum hepatology biobank, all patients with decompensated liver cirrhosis were identified. Patients were assessed for evidence of AKI during baseline hospitalization according to the newest KDIGO definition and followed for adverse outcomes in the ensuing six months. 28-day, 3-month- and 6-month mortality were calculated using Kaplan-Meier analysis.

Results: We observed significant differences in mortality according to AKI stage regardless of interval. A subpopulation of patients with AKI stage 2/3 not fulfilliing CLIF-OF renal failure definition showed similar short-term mortality to ACLF-1, underlining the assumption that absolute creatinine values underestimate mortality risk in this patient population. In ROC analysis, AKI stage and relative as well as absolute change in creatinine had superior predictive capacity for short-term mortality compared to maximal creatinine and CLIF-OF renal failure.

Conclusions: Employment of the KDIGO AKI definition has superior capacity to discriminate at-risk individuals in decompensated cirrhosis. Definitions that use creatinine dynamics should replace stiff maximal creatinine values in assessment for organ failure in liver cirrhosis.

Publication History

Article published online:
20 January 2025