Manuscript title: Acute kidney injury development and impact on clinical and economic outcomes in patients with cirrhosis: an observational cohort study over a 10-year period
Supplementary Table 1: Comorbid conditions among study subjects by AKI status
Comorbidity Total Sample With AKI Without AKI P value
N= 380 n= 106 (27.9%) n= 274 (72.1%)
Myocardial infarction 1 (0.26) 0 (0.0) 1 (0.36) 0.533
Congestive heart failure 22 (5.79) 9 (8.49) 13 (4.74) 0.161
Peripheral vascular disease 0 (0.0) 0 (0.0) 0 (0.0) Cerebrovascular accident or transient
Ischemic attacks 12 (3.16) 5 (4.72) 7 (2.55) 0.28
Dementia 0 (0.0) 0 (0.0) 0 (0.0)
Chronic obstructive pulmonary disease 6 (1.58) 2 (1.89) 4 (1.46) 0.765
Connective tissue disease 0 (0.0) 0 (0.0) 0 (0.0)
Peptic ulcer disease 0 (0.0) 0 (0.0) 0 (0.0)
Diabetes mellitus 180 (47.37) 63 (59.43) 117 (42.70) 0.003
Hemiplegia 1 (0.26) 0 (0.0) 1 (0.36) 0.533
Chronic kidney disease 15 (3.95) 6 (5.66) 9 (3.28) 0.286
Solid tumor 21 (5.53) 8 (7.55) 13 (4.74) 0.284
Leukemia 2 (0.53) 0 (0.0) 2 (0.73) 0.378
Lymphoma 0 (0.0) 0 (0.0) 0 (0.0)
AIDS 0 (0.0) 0 (0.0) 0 (0.0)
Charlson Comorbidity Index* 5.66 ± 2.11 6.48 ± 2.20 5.35 ± 1.99 <0.001 Data are presented as n (%) unless otherwise indicated
*Data are presented as mean ± standard deviation
Supplementary Table 2: The frequency of prescription per the total number of admissions for selected medications in cirrhosis
Medication % of total
admissions#
Lanzoprazole capsule 89.5
Furosemide tab 71.6
Spironolactone tab 67.1
Lactulose syrup 63.2
Human albumin 20% 51.3
Propranolol tab 38.7
Omeprazole inj 36.6
Ceftriaxone inj 30.5
Carvidolol tab 31.5
Ciprofloxacin tab 25.5
Furosemide injection 24.7
Piperacilin+Tazobactam inj 20.5
Metronidazole tab 18.9
Octreotide inj 10.3
Metronidazole inj 8.2
Isosorbide dinitrate 7.6
Cefotaxime inj 2.4
#The total number of admissions was 380.
Supplementary Table 3: Patients demographics and clinical characteristics by discharge status (death vs alive)
Variable Total Sample Death Alive P value
N= 380 n= 72 (18.9%) n= 308 (81.1%)
Age 59.42 ± 19.88 63.56 ± 17.22 58.45 ± 20.36 0.049
Older adults (65 years or
older)* 161 (42.37) 36 (50.0) 125(40.58) 0.145
Gender* 0.932
Male 197 (51.84) 37 (51.39) 160 (51.95)
Female 183 (48.16) 35 (48.61) 148 (48.05)
Body mass index (Kg/m2) 29.10 ± 7.35 29.02 ± 7.89 29.11 ± 7.26 0.9444
Smoking Status* 0.755
Smoker 79 (20.79) 14 (19.44) 65 (21.10)
Non-smoker 301 (79.21) 58 (80.56) 243 (78.90)
Baseline serum creatinine
(mg/dl) 1.16 ± 0.75 1.41 ± 0.86 1.10 ± 0.72 0.001
Length of hospital stay
(median (IQR), days) 4 (2-8) 8 (3-12.5) 3 (2-7) <0.001
AKI* 106 (27.89) 55 (76.39) 51 (16.56) <0.001
Hospital complications*
ICU Transfer 28 (7.37) 28 (38.89) 0 (0.0) <0.001
Hospital acquired
infection 11 (2.89) 6 (8.33) 5 (1.62) 0.002
Acid-base disturbance 96 (25.26) 47 (65.28) 49 (15.91) <0.001 Sodium abnormalities 116 (30.53) 45 (62.50) 71(23.05) <0.001 Potassium abnormalities 87 (22.89) 37 (51.39) 50 (16.23) <0.001 Calcium abnormalities 68 (17.89) 20 (27.78) 48 (15.58) 0.015 Phosphorus abnormalities 53 (13.95) 27 (37.50) 26 (8.44) <0.001 Magnesium abnormalities 27 (7.11) 10 (13.89) 17 (5.52) 0.013
Needs for RRT* 18 (4.7) 5 (6.94) 13 (4.22) 0.327
Comorbidities*
Myocardial infarction 1 (0.26) 1 (1.39) 0 (0.0) 0.038
Congestive heart failure 22 (5.79) 5 (6.94) 17 (5.52) 0.641 Peripheral vascular
disease 0 (0.0) 0 (0.0) 0 (0.0)
Cerebrovascular accident or transient ischemic
attacks 12 (3.16) 2 (2.78) 10 (3.25) 0.838
Dementia 0 (0.0) 0 (0.0) 0 (0.0)
Chronic obstructive
pulmonary disease 6 (1.58) 2 (2.78) 4 (1.3) 0.365
Connective tissue disease 0 (0.0) 0 (0.0) 0 (0.0)
Peptic ulcer disease 0 (0.0) 0 (0.0) 0 (0.0)
Diabetes mellitus 180 (47.37) 34 (47.22) 146 (47.40) 0.978
Hemiplegia 1 (0.26) 0 (0.0) 1 (0.32) 0.628
Chronic kidney disease 15 (3.95) 5 (6.94) 10 (3.25) 0.147
Solid tumor 21 (5.53) 6 (8.33) 15 (4.87) 0.247
Leukemia 2 (0.53) 0 (0.0) 2 (0.65) 0.493
Lymphoma 0 (0.0) 0 (0.0) 0 (0.0)
AIDS 0 (0.0) 0 (0.0) 0 (0.0)
Charlson Comorbidity
Index 5.66 ± 2.11 6.16 ± 2.22 5.54 ± 2.07 0.025
Cirrhosis duration 3.52 ± 4.46 2.67 ± 2.62 3.71 ± 4.75 0.092 Cirrhosis complications*
Ascites 277 (72.89) 56 (77.78) 221 (71.75) 0.3
Portal Hypertension 346 (91.05) 63 (87.50) 283 (91.88) 0.241 Hepatic Encephalopathy 249 (65.53) 50 (69.44) 199 (64.61) 0.437 Spontaneous Bacterial
Peritonitis (SBP) 54 (14.21) 13 (18.06) 41 (13.31) 0.299
Varices 255 (67.11) 40 (55.56) 215 (69.81) 0.021
Cirrhosis etiology*
Hepatitis B 65 (17.11) 14 (19.44) 51 (16.56) 0.558
Hepatitis C 50 (13.16) 15 (20.83) 35 (11.36) 0.032
Nonalcoholic
steatohepatitis 40 (10.53) 5 (6.94) 35(11.36) 0.271
Cirrhosis severity scores
Child Pugh Score 8.60 ± 2.08 9.92 ± 1.56 8.30 ± 2.07 <0.001
MELD-Na 21.81 ± 8.52 30.07 ± 7.5 19.91 ± 7.56 <0.001
Patients’ labs during the admission
Sodium (mmol/l) 135.8 ± 6.14 134.44 ± 7.67 136.11 ± 5.68 0.0383 Potassium (mmol/l) 4.51 ± 0.86 4.83 ± 0.91 4.43 ± 0.83 <0.001 Serum creatinine (mg/dl) 1.49 ± 1.13 2.45 ± 1.36 1.27 ± 0.94 <0.001 Blood urea nitrogen
(mmol/l) 11.53 ± 9.31 19.10 ± 9.88 9.72 ± 8.21 <0.001
Total protein (g/l) 66.08 ± 10.38 60.83 ± 12.10 67.27 ± 9.58 <0.001 Albumin (g/l) 30.82 ± 6.74 27.83 ± 5.64 31.50 ± 6.79 <0.001 Total bilirubin (µmol/l) 85.68 ± 128.14 179.71 ± 223.74 64.17 ± 79.80 <0.001 Direct bilirubin (µmol/l) 61.58 ± 113.82 140.81 ± 200.66 42.38 ± 67.50 <0.001 Alkaline phosphatase (u/l) 269.26 ± 268.67 259.30 ± 234.59 271.56 ± 276.22 0.731 Alanine aminotransferase
(u/l) 38.23 ± 65.55 62.81 ± 122.44 32.47 ± 40.70 <0.001
Aspartate
aminotransferase (u/l) 83.74 ± 206.43 177.18 ± 443.37 61.84 ± 67.36 <0.001 Gamma Glutamyl
Transferase (u/l) 126.11 ± 158.88 92.51 ± 112.63 133.90 ± 166.98 0.049 White blood cells
(*103/mm3) 7.39 ± 5.92 10.35 ± 6.34 6.69 ± 5.60 <0.001
Red blood cells
(*106/mm3) 3.56 ± 1.41 3.51 ± 2.70 3.58 ± 0.86 0.718
Hemoglobin (g/dl) 10.51 ± 2.14 9.88 ± 2.06 10.66 ± 2.14 0.004 Hematocrit (%) 31.12 ± 7.36 28.78 ± 6.49 31.67 ± 7.46 0.002 Platelets (*103/mm3) 115.86 ± 82.01 122.93 ± 109.74 114.16 ± 73.94 0.416
INR 1.83 ± 1.04 2.24 ± 0.78 1.74 ± 1.07 <0.001
PTT (s) 36.66 ± 11.78 40.33 ± 12.12 35.83 ± 11.57 0.014
PT (s) 22.78 ± 9.72 27.11 ± 8.96 21.76 ± 9.63 < 0.001
D-dimer (μg/ml) 6.67 ± 9.21 7.47 ± 5.74 5.71 ± 12.33 0.593 Last labs during admission
Sodium (mmol/l) 137.35 ± 6.58 140.06 ± 10.70 136.71 ± 4.99 <0.001 Potassium (mmol/l) 4.35 ± 0.74 4.80 ± 1.06 4.24 ± 0.59 <0.001 Serum creatinine (mg/dl) 1.51 ± 1.32 2.99 ± 1.87 1.16 ± 0.85 <0.001 Blood Urea Nitrogen 11.36 ± 10.41 22.59 ± 13.45 8.70 ± 7.39 <0.001 AKI Stage*#
Stage I 74 (69.81) 35 (63.64) 39 (76.47) 0.042
Stage II 19 (17.92) 9 (16.36) 10 (19.61)
Stage III 13 (12.26) 11 (20.00) 2 (3.92)
AKI Source*#
Community acquired 68 (64.15) 33 (60.00) 35 (68.63) 0.497
Hospital acquired 26 (24.53) 14 (25.45) 12 (23.53)
ICU acquired 12 (11.32) 8 (14.55) 4 (7.84)
Abbreviations: AKI: acute kidney injury, MELD-Na: Model for End Stage Liver Disease-sodium score, ICU:
intensive care unit, RTT: renal replacement therapy, INR: international normalized ratio, PTT: partial thromboplastin time, PT: prothrombin time.
Data are presented as mean ± standard deviation or median (interquartile range) unless otherwise indicated
*Data are presented as n (%)
#among AKI patients only