EVALUATION OF ALCOHOLIC AND NON-ALCOHOLIC STEATOHEPATITIS-RELATED CHRONIC LIVER DISEASE PATIENTS: A COMPARISON OF CLINICAL PRESENTATION AND SPECTRUM OF ACUTE KIDNEY INJURY
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Keywords
Acute kidney injury, chronic liver disease, alcohol-related liver disease, non-alcoholic steatohepatitis, acute on chronic liver failure
Abstract
Background: Acute kidney injury (AKI) is a frequent and serious complication among patients with chronic liver disease (CLD), significantly impacting morbidity and mortality rates. Despite the rising prevalence of both alcohol-related CLD and non-alcoholic steatohepatitis (NASH)-related CLD globally, comparative data on the clinical presentation and spectrum of AKI in these patient populations are limited.
Methods: In this cross-sectional study, we analyzed 720 patients diagnosed with CLD at our tertiary care centre from January 2023 to June 2024. Patients were categorized into two groups: 360 with alcohol-related CLD and 360 with NASH-related CLD. AKI was identified and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared precipitant factor of AKI, clinical presentations, AKI severity, and patient outcomes between the groups.3
Results: Acute kidney injury (AKI) was observed in 47.5% (171/360) of patients with alcohol-related chronic liver disease (CLD) and in 45.8% (165/360) of patients with non-alcoholic steatohepatitis (NASH)-related CLD (p=0.65). The prevalent precipitating causes for acute kidney injury (AKI) in the alcoholic liver disease (ArLD) and non-alcoholic steatohepatitis (NASH) cohorts were sepsis (69 & 33, p<0.04), urinary tract infection (UTI) (39 & 15, p<0.04), gastrointestinal bleeding (21 & 51, p<0.04), spontaneous bacterial peritonitis (SBP) (21 & 18, NS), gastrointestinal loss (6 & 9, NS), and diuretic overdose (3 & 3, NS). HRS was more prevalent in the NASH group than in the ArLD group (30 vs. 9, p<0.05). The clinical appearance of Acute-on-Chronic Liver Failure (ACLF) was more prevalent in Alcohol-Related Liver Disease (ArLD) (45 vs. 18, p<0.03), but gastrointestinal bleeding was more frequent in the Non-Alcoholic Steatohepatitis (NASH) group (51 vs. 21, p<0.04). In-hospital mortality was markedly elevated in patients with alcohol-related chronic liver disease (CLD) and acute kidney injury (AKI) (28%) compared to those with non-alcoholic steatohepatitis (NASH)-related CLD and AKI (18%) (p=0.04).
Conclusion: Acute Kidney Injury (AKI) is equally prevalent in Alcohol-Related Liver Disease (ArLD) and Non-Alcoholic Steatohepatitis (NASH) related Chronic Liver Disease (CLD). Infections (sepsis and urinary tract infections) are prevalent precipitating factors in alcoholic liver disease, but gastrointestinal bleeding is a frequent precipitant in non-alcoholic steatohepatitis-related chronic liver disease. HRS is more prevalent in NASH than in ArLD.
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Dr. P. Indu Rekha
Assistant Professor, Department of Medicine, Government Medical College, Anantapuramu, Andhra Pradesh, India
Dr. R. Prasanthi
Assistant Professor, Department of Medicine, Government Medical College, Anantapuramu, Andhra Pradesh, India
Dr. K. Manoraju
Associate Professor, Department of Medicine, Government Medical College, Anantapuramu, Andhra Pradesh, India
Dr. B. Padmaja
Assistant Professor, Department of Medicine, Government Medical College, Anantapuramu, Andhra Pradesh, India