Prevalence and outcomes of acute kidney injury in cirrhotic patients admitted to the intensive care unit: A 16-year retrospective cohort study in Saudi Arabia

Objective Acute kidney injury (AKI) in patients with cirrhosis is associated with increased morbidity and mortality in critically ill patients. There is a considerable variation in the reported prevalence of AKI across studies. We provide a unique regional analysis, addressing gaps in AKI data in critically ill cirrhotic patients from the Middle East. Methods In this single-center, retrospective cohort study, we included all patients known to have liver cirrhosis admitted to our tertiary care center over 16 years. Data was extracted from the existing database in the intensive care unit (ICU) department at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Subjects were categorized into four groups using the Kidney Disease Improving Global Outcomes criteria. We evaluated the prevalence of AKI and its association on the in-hospital mortality. Results From 2002 to 2017, 1197 cirrhotic patients were admitted to our ICU. Among them, 68 (5.7%) had stage 1 AKI, 193 (16.1%) had stage 2 AKI, 475 (39.8%) had stage 3 AKI. Overall, in-hospital mortality was progressively higher with worsening severity of AKI, from non-AKI (42.0%) to stage 3 AKI (72.2%), p -value <0.0001. In addition, ICU mortality, hospital and ICU lengths of stay, use of vasopressors and renal replacement therapy were found to increase with worsening severity of AKI. Multivariate analysis demonstrated the following predictors of hospital mortality, the presence of AKI, age, female sex, vasopressor use, increasing bilirubin and lactic acid, and decreasing Glasgow coma scale and PaO2/FiO2 ratio. Conclusions The prevalence of AKI in cirrhotic patients is high and associated with high mortality. Further research is warranted to develop strategies for early detection and management of AKI in this vulnerable population. Future studies integrating national and international data registries could enhance predictive modeling and tailored management for AKI in cirrhotic patients.