Gameiro J, et al. - Given acute kidney injury (AKI) is prevalent in hospitalized patients with cirrhosis and is linked with poor prognosis, researchers used a cohort of cirrhotic patients to develop a risk score for AKI. In cirrhotic patients, a strong discriminative ability to predict AKI was displayed by a new score combining serum creatinine (SCr), Model of End-stage Liver Disease (MELD)-Na and neutrophil-to-lymphocyte ratio (NLR).

Methods

• Cross-examination of the data from a retrospective analysis of 186 patients with cirrhosis admitted to the Gastroenterology and Hepatology Service of Centro Hospitalar Lisboa Norte from January 2003 to December 2005 was carried out.
• The definition of AKI was an increase in serum creatinine (SCr)≥0.3 mg/dL within 48 hours or a percentage increase in SCr≥50% from baseline.
• Researchers used neutrophil-to-lymphocyte ratio (NLR) as a marker for inflammation.
• The discriminative ability of the variables was evaluated by producing a receiver operating characteristic (ROC) curve.
• Cutoff values were defined as those with highest validity.
• The ROC curve was used to evaluate the final AKI risk score model.

Results

• Development of AKI in 52 patients (28%) was reported.
• Independent association of higher baseline SCr (p<0.001), more severe liver disease as evaluated by the modified Model of End-stage Liver Disease (MELD)-Na score (p<0.001) and higher NLR (p=0.028) with AKI was seen.
• Researchers determined the cutoff values with the highest validity for predicting AKI were 0.9 for the SCr, 21.7 for the modified MELD-Na and 6 for the NLR.
• They created risk score allowing 3 points if the SCr is higher than 0.9, 1 point if the modified MELD-Na is higher than 21.7 and 1 point if the NLR is higher than 6.
• For AKI, 0.861 was noted to be the AUROC curve of the risk prediction score.
• With a sensitivity of 88.5% and specificity of 72.4%, AKI in cirrhotic patients was predicted by a risk score of ≥2 points.