The impact of acute kidney injury on mortality and clinical outcomes in patients with alcoholic cirrhosis in the USA

Introduction Acute kidney injury (AKI) is associated with increased morbidity and mortality in patients with chronic liver disease. Although the impact of AKI on patients with liver disease has been established, its impact on alcoholic cirrhosis has not been studied. Methods Our study utilized data from the National Inpatient Sample for the year 2016 for all patients with a diagnosis of alcoholic cirrhosis and AKI. Primary outcomes were mortality, length of stay (LOS) and hospitalization cost were compared. Secondary outcomes were complications of cirrhosis and its impact on mortality. Multivariate logistic regression analysis and propensity-score matching were used to compare the two groups. Results A total of 29 906 patients were included and 6733 (22.5%) had AKI. Propensity-matched multivariate analysis demonstrates that AKI was associated with a significant increase risk of mortality [odds ratio (OR): 8.09; 95% confidence interval (CI), 6.68–9.79; P < 0.0001]. AKI prolonged the hospital stay by 3.68 days (95% CI, 3.42–3.93; P < 0.0001) and increased total hospital charges by $50 284 (95% CI, 45 829–54 739; P < 0.0001). AKI increased the risk of complications of cirrhosis, including hepatorenal syndrome (OR: 19.15; 95% CI, 16.1–22.76), ascites (OR: 2.27; 95% CI, 2.11–2.44), hepatic encephalopathy (OR: 2.54; 95% CI, 1.87–3.47) and portal hypertension (OR: 1.08; 95% CI, 1.01–1.16). Conclusion AKI in alcoholic cirrhosis significantly increases the risk of mortality, hospitalizations costs and LOS. Further studies are needed on addressing renal failure and treatment options for patients with alcoholic cirrhosis.