Serum Creatinine of 1.1 mg/dL Can Indicate Disease Deterioration and 90‐day Mortality in Hospitalized Patients With Cirrhosis in Chinese Population

ABSTRACT Aims Increased serum creatinine (sCR) is associated with increased mortality in cirrhotic patients, while there remains a lack of evidence‐based sCR cutoffs for indicating disease deterioration and predicting 90‐day liver transplantation (LT)‐free mortality in the cirrhotic Chinese population. We aimed to investigate the quantitative relationship between sCR on admission and 90‐day mortality in hospitalized patients with cirrhosis in the Chinese population. Methods Data were prospectively collected from two multicenter cohorts, which enrolled hospitalized patients with chronic liver disease. After screening, 2582 patients with cirrhosis from January 2015 to December 2016 and from July 2018 to January 2019 were included in the primary analysis. Creatinine values were collected on admission. Patients were regularly followed up at the end of 90 days. The univariate and multivariate Cox proportional hazard model was conducted to explore the relationship between sCR and 90‐day LT‐free mortality. A generalized additive model and second derivative (acceleration) were used to plot “creatinine‐mortality correlation curves”, adjusting for potential confounders. Results Among 2582 hospitalized patients with cirrhosis, 428 (16.6%) experienced deaths at the end of 90 days. sCR levels on admission were significantly associated with 90‐day LT‐free mortality in both univariate and multivariate analyses (hazard ratio [HR], 1.77, p < 0.001; HR, 1.22, p = 0.003). sCR of 1.1 mg/dL was identified as the starting point (stage 1a) of disease deterioration of acute kidney injury (AKI) in hospitalized patients with cirrhosis. Patients with 1.1 mg/dL< sCR ≤ 1.8 mg/dL had significantly higher 90‐day mortality compared to those with sCR ≤ 1.1 mg/dL (HR, 1.90, p < 0.001). The corresponding 28‐day and 90‐day LT‐free mortality to sCR 1.1 mg/dL were 11% and 18%, respectively. Conclusions sCR was an independent risk factor for 90‐day LT‐free mortality in hospitalized cirrhotic patients. sCR of 1.1 mg/dL is the starting point of disease deterioration and serves as an important supplement for the diagnostic threshold of AKI stage 1a in the Chinese cirrhotic population without baseline sCR.