The association between mean arterial pressure and acute kidney injury reversal among decompensated cirrhosis patients

This study informs how mean arterial pressure (MAP) impacts AKI recovery among all patients hospitalized with cirrhosis, regardless of etiology.We identified incident AKI episodes among subjects in our cohort of decompensated cirrhosis patients. AKI was defined as a ≥50% increase in creatinine (sCr) from an outpatient baseline (≥7 days prior) that required hospitalization. Linear mixed-effects models were completed to determine the impact between AKI recovery, MAP, and time. To determine the impact of MAP on AKI reversal, we completed time-dependent Cox-regression models with time beginning at the time of peak sCr and ending at death, discharge, or AKI reversal, among those hospitalized with AKI and those with Persistent AKI (≥48 hours).We identified 702 hospitalized cirrhosis patients with AKI. We found those with AKI reversal had, on average, higher MAP (2.1 mmHg, p<0.05) and a greater increase in MAP over time (0.1 mmHg per hour, p<0.001). Among all 702 hospitalized patients with AKI and adjusted for confounders, each 5 mmHg increase in MAP was associated with 1.07x the hazard of AKI reversal (p<0.01). Similarly, among those with persistent AKI after adjusting for confounders, each 5 mmHg increase in MAP was associated with 1.19x greater likelihood of AKI reversal (p<0.001). Discussion: Our data demonstrate that MAP significantly increases the likelihood of AKI recovery regardless of severity or injury or AKI phenotype. We believe these data highlight the importance of MAP as a clinical tool to promote kidney function recovery among cirrhosis patients hospitalized with AKI.