Table 1:
Demographics and clinical characteristics by etiology of acute kidney injury
| All Patients (n = 2063) |
Prerenal AKI (n = 914) |
Hepatorenal Syndrome (n = 249) |
Acute Tubular Necrosis (n = 628) |
P Value | Other AKI (n = 123) |
Unable to Classify (n = 149) |
|
|---|---|---|---|---|---|---|---|
| Age (years) | 62 [54, 69] | 62 [55, 70] | 61 [53, 66] | 61 [51, 68] | <0.001 | 65 [57, 71.5] | 61 [52,68] |
| Female sex (%) | 790 (38.3) | 334 (36.6) | 99 (39.8) | 250 (39.8) | 0.38 | 50 (40.7) | 57 (38.3) |
| White race (%) | 1676 (81.2) | 761 (83.3) | 212 (85.1) | 494 (78.7) | 0.03 | 96 (78.0) | 113 (75.8) |
| Hispanic ethnicity (%) | 180 (8.7) | 90 (9.8) | 24 (9.4) | 38 (6.0) | 0.05 | 9 (7.3) | 19 (12.7) |
| Etiology of cirrhosis (%) | <0.001 | ||||||
| Alcohol | 803 (38.9) | 337 (36.9) | 112 (45.0) | 260 (41.4) | 33 (26.8) | 61 (40.9) | |
| Hepatitis C | 233 (11.3) | 114 (12.5) | 25 (10.0) | 63 (10.0) | 16 (13.0) | 15 (10.1) | |
| Non-alcoholic steatohepatitis | 444 (21.5) | 201 (22.0) | 71 (28.5) | 112 (17.8) | 27 (22.0) | 33 (22.1) | |
| Multifactorial | 191 (9.3) | 94 (10.3) | 14 (5.6) | 61 (9.7) | 13 (10.6) | 9 (6.0) | |
| Other | 392 (19.0) | 168 (18.4) | 27 (10.8) | 132 (21.0) | 34 (27.6) | 31 (20.8) | |
| Complications of cirrhosis (%) | |||||||
| Ascites | 1607 (77.9) | 643 (70.4) | 242 (97.2)*** | 512 (81.5) | <0.001 | 89 (72.4) | 121 (81.2) |
| Encephalopathy | 1212 (58.8) | 497 (54.4) | 174 (69.9) | 405 (64.6) | <0.001 | 45 (36.6) | 91 (61.1) |
| Gastrointestinal bleeding | 712 (34.5) | 303 (33.2) | 80 (32.1) | 253 (40.4) | 0.007 | 33 (26.8) | 43 (28.9) |
| Spontaneous bacterial peritonitis | 289 (14.0) | 111 (12.2) | 50 (20.1) | 102 (16.3) | 0.003 | 10 (8.2) | 16 (10.7) |
| Hepatocellular carcinoma | 236 (11.4) | 106 (11.6) | 33 (13.3) | 68 (10.8) | 0.60 | 11 (8.9) | 18 (12.1) |
| Characteristics of admission | |||||||
| Admission mean arterial pressure (mmHg) | 69.0 [60.7, 77.0] | 70.0 [62.3, 78.0] | 69.0 [61.3, 76.0] | 64.8 [56.7, 74.0] | <0.001 | 73.3 [66.0, 82.3] | 71.7 [64.3, 79.3] |
| Vasoconstrictors for HRS (%) | 788 (38.2) | 196 (21.5) | 192 (77.1) | 307 (49.0) | <0.001 | 25 (20.3) | 68 (45.6) |
| Vasopressors for shock (%) | 614 (29.8) | 139 (15.2) | 83 (33.6)**** | 331 (52.7) | <0.001 | 23 (18.7) | 38 (25.5) |
| Albumin given during admission (%) | 1370 (66.5) | 503 (55.1) | 235 (94.8) | 480 (76.7) | <0.001 | 54 (43.9) | 98 (65.8) |
| Total albumin given during admission in g | 122 [75, 175] | 101 [50, 175] | 144 [100, 200] | 100 [63, 175] | <0.001 | 125 [75, 175] | 100 [50, 184] |
| Intensive care admission (%) | 963 (46.7) | 267 (29.2) | 132 (53.2) | 464 (74.0) | <0.001 | 39 (31.7) | 61 (40.9) |
| Mechanical ventilation (%) | 551 (26.7) | 130 (14.2) | 68 (27.2) | 304 (48.4) | <0.001 | 18 (14.6) | 31 (20.9) |
| Renal replacement therapy (%) | 374 (18.2) | 25 (2.7) | 65 (26.1) | 234 (37.3) | <0.001 | 8 (6.5) | 42 (28.4) |
| Medications prior to admission (%) | |||||||
| Loop diuretic | 1295 (62.8) | 621 (68.0) | 155 (62.2) | 357 (56.9) | <0.001 | 74 (60.2) | 88 (59.1) |
| Mineralocorticoid receptor antagonist | 951 (46.2) | 466 (51.2) | 116 (46.6) | 256 (40.8) | 0.001 | 57 (46.3) | 56 (37.6) |
| Beta blockers | 831 (40.3) | 415 (45.4) | 75 (30.1) | 238 (37.9) | <0.001 | 55 (44.7) | 48 (32.2) |
| MELD-Na score | 26 [19, 31] | 24 [18, 29] | 30 [25, 34] | 28 [21, 34] | <0.001 | 22 [17, 26] | 26 [19, 34] |
| CLIF-C ACLF score | 48.8 [42.4, 55.7] | 45.3 [40.5, 51.2] | 51.3 [45.0, 56.2] | 54.0 [47.3, 60.9] | <0.001 | 47.2 [40.1, 51.7] | 49.1 [41.2, 57.4] |
| Laboratory values | |||||||
| Sodium (mEq/L) | 134 [130, 138] | 135 [131, 138] | 131 [127, 136] | 134 [130, 138] | <0.001 | 135 [131, 139] | 135 [129, 139] |
| Outpatient baseline creatinine* (mg/dL) | 1.10 [0.87, 1.37] | 1.11 [0.90, 1.35] | 1.10 [0.90, 1.45] | 1.05 [0.79, 1.32] | 0.01 | 1.24 [0.99, 1.49] | 1.11 [0.86, 1.50] |
| Admission creatinine (mg/dL) | 1.84 [1.50, 2.48] | 1.84 [1.50, 2.48] | 2.32 [1.67, 3.26] | 2.02 [1.34, 3.27] | <0.001 | 1.86 [1.52, 2.64] | 2.10 [1.37, 3.33] |
| Peak creatinine (mg/dL) | 2.55 [1.93, 3.66] | 2.08 [1.72, 2.70] | 3.36 [2.42, 4.58] | 3.24 [2.34, 4.71] | <0.001 | 2.43 [1.90, 3.30] | 2.94 [2.12, 4.60] |
| White blood count (K/uL) | 8.6 [6.0, 12.9] | 8.0 [5.6, 11.6] | 9.6 [6.1, 14.3] | 9.8 [6.6, 14.7] | <0.001 | 7.3 [5.1, 10.2] | 8.7 [6.1, 12.9] |
| Hematocrit (%) | 29.6 [25.0, 34.9] | 30.9 [25.7 36.3] | 28.4 [23.9, 32.2] | 28.9 [24.3, 33.7] | <0.001 | 31.0 [27.5, 35.7] | 28.2 [24.6, 33.4] |
| Platelets (K/uL) | 114 [73, 172] | 116 [76, 177] | 106 [70, 153] | 112 [69, 168] | 0.05 | 141 [85, 191] | 122 [75, 164] |
| Albumin (g/dL) | 2.90 [2.50, 3.60] | 3.00 [2.60, 3.60] | 2.80 [2.40, 3.20] | 2.80 [2.30, 3.20] | <0.001 | 3.10 [2.70, 3.40] | 2.90 [2.50, 3.40] |
| International normalized ratio (INR) | 1.60 [1.30, 2.10] | 1.50 [1.21, 1.90] | 1.70 [1.40, 2.22] | 1.80 [1.40, 2.50] | <0.001 | 1.40 [1.20, 1.88] | 1.60 [1.30, 2.10] |
| Total bilirubin (mg/dL) | 2.6 [1.1, 7.0] | 2.0 [0.9, 4.4] | 4.2 [1.8, 11.5] | 3.5 [1.6, 11.0] | <0.001 | 1.4 [0.7, 2.5] | 3.2 [1.2, 9.0] |
| Fractional excretion of sodium** (%) | 0.35 [0.17, 0.91] | 0.33 [0.13, 0.91] | 0.25 [0.17, 0.53] | 0.41 [0.17, 1.18] | 0.001 | 0.60 [0.19, 1.99] | 0.39 [0.14, 0.94] |
Key: AKI (acute kidney injury), MELD-Na (Model for End Stage Liver Disease-Sodium), CLIF-C ACLF (CLIF Consortium Organ Failure Acute on Chronic Liver Failure Score). MELD and CLIF-C ACLF score were taken at hospital admission. All laboratory values were taken at admission unless otherwise noted.
Continuous variables given as median [interquartile range]. P values represent a three-way comparison between prerenal AKI, hepatorenal syndrome, and ATN, calculated by Chi square (categorical variables), Student’s t test (parametric continuous variables) or Wilcoxon rank sum (non-parametric continuous variables).
*
Available in 1700 patients.
**
Available in 1149 patients.
***
Presence of ascites is required for the diagnosis of HRS-AKI. Complications of cirrhosis were recorded at the time of admission, and thus, some patients were found to have ascites after admission, but before the diagnosis of HRS-AKI.
****
Patients with HRS-AKI may have developed shock requiring vasopressors after the diagnosis of HRS-AKI was made.