JMIR Publications

ABSTRACT

Background:

Patients with cirrhosis may have acute kidney injury (AKI) after receiving Endoscopic retrograde cholangiopancreatography (ERCP).

Objective:

This study aims to identify predictors of the AKI that requires dialysis following ERCP in patients with cirrhosis.

Methods:

Data from the United States Nationwide Inpatient Sample from 2016 to 2020 were retrospectively reviewed. Patients ≥ 20 years old with liver cirrhosis who underwent ERCP were identified. The primary outcome was AKI requiring dialysis. Logistic regression analyses and stepwise selection were performed to identify independent predictors among patient demographic data, comorbidities, and hospital characteristics AKI requiring dialysis.

Results:

Data of 6,748 patients with liver cirrhosis who underwent ERCP were analyzed, and 1.7% developed AKI that required dialysis. After adjustment, the results showed that decompensated liver cirrhosis (adjusted odds ratio [aOR] = 4.73, 95% confidence interval [CI]: 3.12-7.15), chronic kidney disease (CKD) (aOR = 5.93, 95% CI: 4.00-8.79), obesity (aOR = 1.65, 95% CI: 1.05-2.59), and sepsis (aOR = 3.57, 95% CI: 2.44-5.23) were significant factors associated with AKI that required dialysis. The model developed demonstrated good calibration and discrimination (c-index: 0.826 for derivation cohort, 0.824 for validation cohort).

Conclusions:

Decompensated liver cirrhosis, pre-existing CKD, obesity, and sepsis are significant predictors of AKI that requires dialysis following ERCP in patients with liver cirrhosis. These findings can inform risk stratification and management strategies to improve outcomes in this high-risk population.