Incidence, Predictors and Outcome of Acute Kidney Injury in Patients with Nosocomial Spontaneous Bacterial Peritonitis

2016 ◽  
Vol 64 (2) ◽  
pp. S666
Author(s):  
R. Maiwall ◽  
S.K. Sarin
Keyword(s):  
Acute Kidney Injury ◽  
Spontaneous Bacterial Peritonitis ◽  
Kidney Injury ◽  
Bacterial Peritonitis

Trends in Hospitalization, Acute Kidney Injury, and Mortality in Patients With Spontaneous Bacterial Peritonitis

2019 ◽  
Vol 53 (2) ◽  
pp. e68-e74 ◽  
Author(s):  
Kalpit Devani ◽  
Paris Charilaou ◽  
Palashkumar Jaiswal ◽  
Nirav Patil ◽  
Dhruvil Radadiya ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Spontaneous Bacterial Peritonitis ◽  
Kidney Injury ◽  
Bacterial Peritonitis

scholarly journals Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury

2021 ◽  
Vol 10 (23) ◽  
pp. 5621
Author(s):  
Roula Sasso ◽  
Ahmad Abou Yassine ◽  
Liliane Deeb
Keyword(s):  
Acute Kidney Injury ◽  
Spontaneous Bacterial Peritonitis ◽  
Hepatorenal Syndrome ◽  
Kidney Injury ◽  
Alcoholic Cirrhosis ◽  
Clinical Feature ◽  
Decompensated Liver Cirrhosis ◽  
Bacterial Peritonitis ◽  
Cirrhotic Patients ◽  
End Stage

Hepatorenal syndrome (HRS) is a type of acute kidney injury (AKI), occurring in patients with decompensated liver cirrhosis and is associated with high mortality. We aim to describe the predictors associated with the development of HRS in cirrhotic patients with AKI. We retrospectively analyzed 529 cirrhotic patient encounters with AKI across all Northwell Health institutions between 1 January 2015 and 31 December 2018. We performed multivariate analyses to determine independent predictors of development of HRS. Alcoholic cirrhosis was the most common identified etiology of cirrhosis. The mean Model for End-Stage Liver Disease Scorewas18 (±7). Ascites was the most commonly identified clinical feature of portal hypertension. Infection was identified in 38.4% of patients with urinary tract infection/pyelonephritis being the most common. Spontaneous bacterial peritonitis occurred in 5.9% of patients. The most common cause of AKI was pre-renal. Hepatorenal syndrome was identified in 9.8% of patient encounters. Predictors of HRS were history of ascites, serum creatinine >2.5 mg/dL, albumin <3 g/dL, bilirubin >2 mg/dL and spontaneous bacterial peritonitis. We demonstrate strong predictors for the development of HRS which can aid clinicians to attain an early diagnosis of HRS, leading to prompt and targeted management and improving outcomes.

Albumin Utilization in Spontaneous Bacterial Peritonitis

2021 ◽  
pp. 089719002199700
Author(s):  
Alex M. Ebied ◽  
Thakul Rattanasuwan ◽  
Yiqing Chen ◽  
Adonice P. Khoury
Keyword(s):  
High Risk ◽  
Spontaneous Bacterial Peritonitis ◽  
Total Bilirubin ◽  
Kidney Injury ◽  
Inclusion Criteria ◽  
Dosing Regimen ◽  
Bacterial Peritonitis ◽  
Risk Patients ◽  
The Impact ◽  
Order Set

Background: Albumin has been shown to decrease the incidence of mortality and acute kidney injury (AKI) in patients with spontaneous bacterial peritonitis (SBP). Albumin administration in SBP is recommended within 6 hours of diagnosis and for reserved use in high-risk patients with the following baseline laboratory tests: serum creatinine >1 mg/dL, blood urea nitrogen >30 mg/dL or total bilirubin >4 mg/dL. Objective: We aimed to assess the impact of an albumin order set restricted to high-risk SBP. Methods: A retrospective cohort study was conducted between Jan 1, 2013 to Feb 28, 2018. The albumin order set was implemented on Sep 20, 2016. Patients were included if they were diagnosed with SBP and had an ascitic fluid polymorphonuclear count ≥ 250 cells/mm3. Results: Out of a total of 137 patients reviewed, 88 met the inclusion criteria. The incidence of AKI in the pre-order set and post-order set were 63.93% and 33.33% (p = 0.01), respectively. The incidence of mortality in the pre-order set and post-order set were 36.07% and 7.41% (p = 0.005), respectively. The percentage of patients administered albumin within 6 hours were 24.59% to 40.74% (p = 0.14) in the pre-order set and post-order set, respectively. The percentage of patients who received the recommended albumin dosing regimen ordered was 42.62% vs 96.30% (p < 0.001), in the pre-order set and post-order set, respectively. Conclusion: The albumin order set restricted to high-risk SBP patients significantly reduced the incidence of AKI and mortality, and improved the appropriateness of albumin regimen ordered.

Profile of Acute Kidney Injury in Patients with Decompensated Cirrhosis at a Tertiary-Care Center in Uttarakhand, India

2019 ◽  
Vol 38 (4) ◽  
pp. 335-343
Author(s):  
Manjot S. Arora ◽  
Reshma Kaushik ◽  
Shahbaj Ahmad ◽  
Rajeev Mohan Kaushik
Keyword(s):  
Acute Kidney Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Kidney Injury ◽  
International Normalized Ratio ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Total Leucocyte Count ◽  
Bacterial Peritonitis ◽  
Ctp Score

Objectives: To study the clinical profile and predictors of acute kidney injury (AKI) in patients with decompensated cirrhosis. Materials and Methods: This observational study was conducted at Himalayan Institute of Medical Sciences, Dehradun, India, on 175 consecutive patients with decompensated cirrhosis. Patients were studied for AKI as per International Club of Ascites-AKI criteria. Results: The prevalence of AKI was 40.6%, with prerenal AKI 67.6%, hepatorenal syndrome (HRS) 23.8%, intrinsic renal AKI 7%, and postrenal AKI 1.4%. Mean arterial pressure (MAP), platelet count, and serum albumin were significantly lower and total leucocyte count (TLC), blood urea nitrogen, serum creatinine (SCr), total bilirubin, aspartate aminotransferase, international normalized ratio, Child-Turcotte-Pugh (CTP) score, and model for end-stage liver disease (MELD) score higher in cirrhosis patients with AKI than without AKI (p < 0.05 each). MAP, hemoglobin, TLC, and SCr were significantly different in various types of AKI (p < 0.05 each). AKI had a significant association with CTP score, alcohol, spontaneous bacterial peritonitis (SBP), sepsis, and shock (p < 0.05 each). Type of AKI had significant association with SBP, sepsis, and shock (p < 0.05 each). Mortality occurred in 33.8% patients with AKI with 64.7% mortality in patients with HRS. Outcome had significant association with AKI, stage and type of AKI (p < 0.05 each). Multivariate analysis showed SBP, sepsis, and shock as independent predictors of AKI (p < 0.05 each). Conclusions: AKI occurred commonly in patients with decompensated cirrhosis. Prerenal AKI and HRS were the most common types of AKI. SBP, sepsis, and shock were important predictors of AKI.

scholarly journals Rifaximin has the potential to prevent complications of cirrhosis

2018 ◽  
Vol 11 ◽  
pp. 175628481880030 ◽  
Author(s):  
Steven L. Flamm ◽  
Kevin D. Mullen ◽  
Zeev Heimanson ◽  
Arun J. Sanyal
Keyword(s):  
Acute Kidney Injury ◽  
Variceal Bleeding ◽  
Hepatorenal Syndrome ◽  
Kidney Injury ◽  
International Normalized Ratio ◽  
Meld Score ◽  
Bacterial Peritonitis ◽  
Complications Of Cirrhosis ◽  
End Stage ◽  
Post Hoc

Background: Cirrhosis-related complications are associated with poor prognosis. With our analyses, we examined the potential benefit of rifaximin in reducing the risk of developing cirrhosis-related complications. Methods: Adults with cirrhosis and hepatic encephalopathy (HE) in remission were randomly assigned to receive rifaximin 550 mg twice daily or placebo for 6 months with concomitant lactulose permitted. Post hoc analyses examined time to cirrhosis-related complications (HE, spontaneous bacterial peritonitis (SBP), variceal bleeding, acute kidney injury/hepatorenal syndrome). Subgroup analyses evaluated efficacy for select baseline disease characteristics. Results: Of patients receiving rifaximin ( n = 140) and placebo ( n = 159), 53.6% and 49.1%, respectively, had baseline Model for End-Stage Liver Disease (MELD) score ⩾ 12 and international normalized ratio (INR) ⩾ 1.2. Baseline ascites was observed in 36.4% (rifaximin) and 34.6% (placebo) of patients. In patients with MELD score ⩾ 12 and INR ⩾ 1.2, rifaximin reduced the relative risk (RR) of any first complication experienced during trial by 59% [hazard ratio (HR) = 0.41, 95% confidence interval (CI): 0.25–0.67; p < 0.001] versus placebo. For patients with baseline ascites, rifaximin reduced the RR of any first complication experienced during trial by 42% versus placebo (HR = 0.58, 95% CI: 0.34–1.0; p = 0.045). For some subgroups, there was a decrease in RR of complications of SBP, variceal bleeding, and acute kidney injury/hepatorenal syndrome with rifaximin versus placebo, although there were few events reported in the study. Conclusion: Rifaximin may reduce the incidence of cirrhosis-related complications and the recurrence of overt HE. [ ClinicalTrials.gov identifier: NCT00298038.]

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