Identification of Subclasses of Decompensated Cirrhotic Patients with Acute Kidney Injury with Different Responses to Fluid Input.

ABSTRACT

INTRODUCTION: Acute kidney injury is a heterogeneous disease in decompensated cirrhotic patients. The aims of our study were to detect subphenotypes of cirrhotic patients with acute kidney injury (AKI) and explore clinical traits in patients with different subclasses. METHODS: All enrolled patients were identified from a clinical database. Clinical and laboratory variables were used to perform latent profile analysis (LPA). Clinical traits in each class were compared. A multivariable logistic regression model and a Cox model were used to explore the independent association of fluid input and mortality outcome. RESULTS: A total of 439 AKI patients with decompensated cirrhosis were enrolled in our study, including 113 patients in profile 1 and 326 patients in profile 2, by the LPA model. Profile 1 had higher mortality (61.1%) than profile 2 (36.81%). Moreover, profile 1 had a higher MELD score (median 39, interquartile range 34-43) than profile 2 (p < 0.001). Higher cumulative fluid input in the first 24 h for profile 1 was associated with an increased risk of hospital mortality (odds ratio 1.33, 95% CI 1.02-1.75) and 90-day mortality (hazard ratio 1.39, 95% CI 1.08-1.78). CONCLUSIONS: In this study, two distinct subclasses of decompensated cirrhotic patients with AKI were identified, with different clinical outcomes and fluid input responses.