Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Saturday, 09 / 26 / 2020




Incidence, Mortality and Predictors of Acute Kidney Injury in Patients with Cirrhosis: A Systematic Review and Meta-analysis

Raseen Tariq1, Yousaf Hadi2Khusdeep Chahal3Sivani Reddy3Habeeb Salameh4 and  Ashwani K. Singal*,5

1  Department of Medicine, Rochester General Hospital, Rochester, NY, USA
2  Department of Medicine, University of West Virginia, Morgantown, WV, USA
3  University of Alabama at Birmingham, Birmingham, AL, USA
4  Department of Gastroenterology, University of Texas Medical Branch, Galveston, TX, USA
5  Division of Gastroenterology and Hepatology, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
*Correspondence to: Ashwani K. Singal, Avera University Hospital, University of South Dakota, Institute of Human Genetics Research, Sioux Falls, SD 57105, USA. Tel: +1-605-322-8545, Fax: +1-605-322-8536, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2020;8(2):135-142 DOI: 10.14218/JCTH.2019.00060
Received: December 18, 2019 Accepted: lFebruary 25, 2020 Published onlineMay 25, 2020


Background and Aims: Acute kidney injury (AKI) is common in patients with cirrhosis but the incidence is heterogeneous among studies. We performed a meta-analysis to describe the incidence of AKI and its impact on patient mortality in patients with cirrhosis. We also evaluated the admission variables predicting development of AKI.

Methods: A systematic search of various databases was performed up to November 2018. Meta-analyses were performed using random effects models.

Results: Of 18,474 patients with cirrhosis from 30 selected studies, 5,648 developed AKI, with a pooled incidence of 29% (95% confidence interval [CI]: 28-30%, I2 of 99%). In-hospital mortality assessed in eight studies was six-fold higher among AKI patients, as compared to those without AKI (odds ratio [OR] 6.72, 95% CI: 3.47-13, p<0.0001, I2 of 70%). Three studies on patients admitted to intensive care showed about six-fold higher mortality among AKI patients (OR 5.90, 95% CI: 3.21-10.85, p>0.0001). Mortality remained significantly high, at days 30 and 90 and even at 1-year follow up after development of AKI. Of 12 admission variables analyzed, model for end-stage liver disease score, Child-Pugh-Turcotte stage C, presence of ascites, and presence of sepsis/septic shock were statistically significant risk factors for AKI.

Conclusions: AKI occurred in about 29% of patients with cirrhosis and is associated with a six-fold increased risk of in-hospital mortality. Mortality remained high even in long-term follow-up of 1 year. Patients at risk for AKI development can be recognized at admission. Prospective studies are needed to develop strategies for improving outcome of these patients.


Acute kidney injury, Cirrhosis, Mortality, Outcomes

Journal of Clinical and Translational Hepatology 2020 vol. 8, 135-142  [ Html  ] [ PDF Full-text ]

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.


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