Early echocardiographic signs of diastolic dysfunction predict acute kidney injury in cirrhotic patients.

BACKGROUND: Cardiovascular dysfunction in cirrhotic patients affect survival and the development of cirrhotic complications. We aimed to evaluate potential echocardiographic parameters to predict mortality and acute kidney injury (AKI) in cirrhotic patients.

METHODS: Total 103 cirrhotic patients who underwent echocardiography between February 2009 and August 2016 in Taipei Veterans General Hospital were retrospectively enrolled. Cardiac function was evaluated using transthoracic two-dimensional echocardiography with tissue Doppler imaging. Cox hazard regression analysis was used for assessing predictors for one-year mortality and AKI within one year.

RESULTS: Baseline echocardiographic parameters were similar between survivors (n= 92) and non-survivors (n= 11). Lower serum levels of albumin, as well as higher albumin-bilirubin (ALBI) scores, Child-Pugh scores, and MELD scores were observed in non-survivors. Cox proportional hazard regression analysis revealed Child-Pugh score as the only predictor of one-year mortality. Baseline serum Cr > 1.5 mg/dL, TB > 2 mg/dL and a higher E/e' ratio predict occurrence of AKI within one year. Among patients with serum Cr < 1.5 mg/dL, an increased atrial filling velocity and higher ALBI scores predict AKI occurrence within one year.

CONCLUSION: Severity of underlying liver disease but not echocardiographic parameters predicts one-year mortality in cirrhosis. Early echocardiographic signs of diastolic dysfunction and higher ALBI scores may predict development of acute kidney injury in cirrhotic patients with serum Cr < 1.5 mg/dL.