Early prediction of acute kidney injury after therapeutic paracentesis in decompensated liver cirrhosis: diagnostic value of IL-18, KIM-1, and FGF-23

Acute kidney injury (AKI) is a potentially fatal complication in patients with decompensated cirrhosis having therapeutic paracentesis, and early diagnosis is still difficult because of the low sensitivity of serum creatinine. We preemptively tested serum interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and fibroblast growth factor-23 (FGF-23) in early prediction of post-paracentesis AKI in 80 hospitalized patients with tense ascites and normal baseline kidney function. Samples of blood were collected 2 h pre-paracentesis and 24 h post-paracentesis. Based on the Kidney Disease: Improving Global Outcomes definition, AKI, which happened within 72 h, was present in 40% of patients. Biomarkers levels at baseline were comparable. In 24 h of paracentesis, IL-18, KIM-1, and FGF-23 were high in patients who later developed AKI (all p value below .001) and had high-absolute changes than the non-AKI group. The largest discriminative performance was observed of FGF-23 (area under the curve 0.959), then IL-18 (0.931), and KIM-1 (0.903). In multivariate logistic regression controlling MELD-Na score, serum albumin, baseline eGFR and ascitic fluid volume, the post-paracentesis FGF-23 was still independently connected with AKI. Biomarkers of tubular injury, especially FGF-23, which increased shortly after the procedure were strongly correlated with future AKI and could increase risk stratification pending external validation.