Incidence and mortality of renal dysfunction in cirrhotic patients with acute gastrointestinal bleeding: a systematic review and meta-analysis

Bai, Zhaohui; Primignani, Massimo; Guo, Xiaozhong; Zheng, Kexin; Li, Hongyu; Qi, Xingshun

doi:10.1080/17474124.2019.1694904

Cited by 19 publications

(17 citation statements)

References 32 publications

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“…In detail, it is significantly related to higher mortality in cirrhotic patients accompanied with different decompensation events, such as infection (i.e., spontaneous bacterial peritonitis, cellulitis, or other types of infection) [21][22][23], ascites [24][25][26], acute-on-chronic liver failure [27], and critical illness [28]. Recently, our meta-analysis confirmed that renal dysfunction significantly increased a 4.92-fold risk of death in cirrhotic patients with acute GIB [29]. In consistency with previous studies, the present study has demonstrated that both ICA-AKI stages 1B-3 and renal dysfunction significantly increased the risk of in-hospital death.…”

Section: Discussionmentioning

confidence: 52%

Terlipressin May Decrease In-Hospital Mortality of Cirrhotic Patients with Acute Gastrointestinal Bleeding and Renal Dysfunction: A Retrospective Multicenter Observational Study

Liu

Lin

et al. 2020

Adv Ther

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Background: Acute gastrointestinal bleeding (GIB) rapidly reduces effective blood volume, thereby precipitating acute kidney injury (AKI). Terlipressin, which can induce splanchnic vasoconstriction and increase renal perfusion, has been recommended for acute GIB and hepatorenal syndrome in liver cirrhosis. Thus, we hypothesized that terlipressin might be beneficial for cirrhotic patients with acute GIB and renal impairment. Methods: In this Chinese multi-center study, 1644 cirrhotic patients with acute GIB were retrospectively enrolled. AKI was defined according to the International Club of Ascites (ICA) criteria. Renal dysfunction was defined as serum creatinine (sCr) [ 133 lmol/L at admission and/or any time point during hospitalization. Incidence of renal impairment and inhospital mortality were the primary end-points.

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Section: Discussionmentioning

confidence: 52%

Terlipressin May Decrease In-Hospital Mortality of Cirrhotic Patients with Acute Gastrointestinal Bleeding and Renal Dysfunction: A Retrospective Multicenter Observational Study

Liu

Lin

et al. 2020

Adv Ther

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“…Wong et al [36] also observed a 34% mortality rate in 30 days. Results of meta-analysis demonstrated that the overall mortality of renal dysfunction among patients with liver cirrhosis and UGIB was 46%, with significant heterogeneity [37]. In the current study, the mortality rate among patients with AKI was as high as 64.0%.…”

Section: Discussionmentioning

confidence: 49%

Acute Kidney Injury in Patients with Liver Cirrhosis: Prevalence, Predictors, and In-Hospital Mortality at a District Hospital in Ghana

Duah

Duah²,

Ampofo-Boobi³

et al. 2022

BioMed Research International

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Background. Acute kidney injury (AKI) is one of the most severe complications of cirrhosis and portends an ominous prognosis with an estimated mortality of about 50% in a month and 65% within a year. Infection and hypovolemia have been found to be the main precipitating factors of AKI in liver cirrhosis. Early detection and treatment of AKI may improve outcomes. AKI in patients with liver cirrhosis in Ghana and their impact on inpatient mortality are largely unknown. This study was aimed at determining the prevalence, precipitating factors, predictors, and in-hospital mortality of AKI in patients with liver cirrhosis admitted to a district hospital in Ghana. Methods. Consecutive hospitalized patients with liver cirrhosis from 1 January 2018 to 30 April 2020 were recruited. Patient’s demographic data and clinical features were collected using a standardized questionnaire. Biochemical and haematological tests as well as abdominal ultrasound scans were done for all patients. All patients were then followed up until discharge or death. Results. There were 117 (65.4%) males out of the 179 patients with a mean age of 49.94 and 45.84 years for those with and without AKI, respectively. The prevalence of AKI was 27.9% (50/179). Out of 50 participants with AKI, 64.0% (32/50) died, contributing 41.0% of all in-patient mortality amongst participants. There was a significant association between AKI and death ( p ≤ 0.001 ). The major precipitating factors of AKI were infections (60.0%), hypovolemia (20.0%) due to gastrointestinal bleeding and gastroenteritis, and refractory ascites (16.0%). Alkaline phosphatase, INR, model for end-stage liver disease sodium, sodium, and blood urea nitrogen were independent predictors of AKI. Conclusion. AKI was common among patients with liver cirrhosis with high in-patient mortality. Identification of these precipitants and independent predictors of AKI may lead to prompt and targeted treatment with reduction in patient mortality.

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“…This study, which included 546 episodes in patients diagnosed with cirrhosis and active gastroesophageal variceal bleeding, showed an overall incidence of 28% and 17.8% for AKI diagnosed using the ICA and conventional criteria within 42 days, respectively. A previous meta-analysis focusing on gastrointestinal bleeding in patients with cirrhosis reported an incidence of 21% of renal dysfunction, but the incidence of renal dysfunction according to the new AKI diagnostic criteria was up to 25% [ 22 ]. These findings suggest that the ICA-AKI criteria can detect renal dysfunction in patients with AVB earlier than the conventional criteria.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there was a 3.0-fold increase in the risk of 6-week mortality rate in patients with AKI than in those without AKI. A previous meta-analysis suggested that renal dysfunction increased the risk of mortality among patients with cirrhosis and acute gastrointestinal bleeding [ 22 ]. In a previous study of 113 patients with cirrhosis and gastric variceal bleeding conducted by Hsieh [ 14 ], the 6-week mortality rate in patients with ICA-AKI (37%) was higher than that in those without ICA-AKI (3%, P < 0.001), and AKI stages were independent predictors of 3-month survival.…”

Section: Discussionmentioning

confidence: 99%

Impact of acute kidney injury on mortality in patients with acute variceal bleeding

Kim

Lee

et al. 2021

BMC Gastroenterol

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Background The effect of acute kidney injury (AKI) on patients with acute variceal bleeding (AVB) using the recently proposed International Club of Ascites (ICA) criteria is unclear. This study aimed to evaluate the incidence of AKI using the ICA criteria and factors associated with the outcomes in cirrhotic patients with AVB. Methods This retrospective cohort study included data of cirrhotic patients with AVB from two centers in Korea. The association of the ICA criteria for AKI with 6-week mortality was analyzed through univariate and multivariate analyses using the Cox proportional hazard model. Results In total, there were 546 episodes of AVB in 390 patients, of which 425 and 121 episodes were due to esophageal and gastric variceal bleeding, respectively. Moreover, 153 patients fulfilled the ICA criteria for AKI, and 64, 30, 39, and 20 patients were diagnosed with stages 1a, 1b, 2, and 3, respectively. Conversely, 97 patients developed AKI within 42 days as per the conventional criteria. The 6-week mortality rate was significantly higher in patients with ICA-AKI than in patients without ICA-AKI; the occurrence of ICA-AKI was an independent factor for predicting the 6-week mortality. Conclusion The ICA criteria could help diagnose renal dysfunction earlier, and presence of AKI is a predictor of mortality in patients with cirrhosis and AVB.

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Incidence and mortality of renal dysfunction in cirrhotic patients with acute gastrointestinal bleeding: a systematic review and meta-analysis

Cited by 19 publications

References 32 publications

Terlipressin May Decrease In-Hospital Mortality of Cirrhotic Patients with Acute Gastrointestinal Bleeding and Renal Dysfunction: A Retrospective Multicenter Observational Study

Terlipressin May Decrease In-Hospital Mortality of Cirrhotic Patients with Acute Gastrointestinal Bleeding and Renal Dysfunction: A Retrospective Multicenter Observational Study

Acute Kidney Injury in Patients with Liver Cirrhosis: Prevalence, Predictors, and In-Hospital Mortality at a District Hospital in Ghana

Impact of acute kidney injury on mortality in patients with acute variceal bleeding

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