Postdischarge Follow-Up of Patients with Liver Disease and AKI

Background: Acute Kidney Injury (AKI) in the setting of liver disease is complicated and associated with adverse outcomes, but much of the data is from the Intensive Care Unit. We sought to better understand the outcomes for ward-based patients with cirrhosis and AKI. Methods: We conducted quality initiative via a retrospective chart review of all patient encounters on the Liver Hospitalist Service from January 1st – June 31st, 2023 with at least 2 serum creatinines (SCr). Baseline SCr function was defined as the mean SCr within 6 months to 1 year prior to admission. Diagnosis and staging of AKI was based on KDIGO SCr-criteria. Diagnosis of liver cirrhosis and of source of AKI was determined via chart review. The outcomes of interest were around incidence and severity of AKI, inpatient nephrology consultation, and post-discharge follow up. Results: Of 141 admissions, 23 patients had multiple encounters during the study period. The final cohort consisted of 103 patients, 59 (57%) who had cirrhosis, 34 (33%) who had history of liver transplant, 5 (5%) with acute liver injury, and 5 (5%) with other. Of those with cirrhosis, 24 (41%) had AKI on admission or developed AKI during their hospitalization (Table). The etiologies of AKI included: Volume-responsive (11), Hepatorenal Syndrome (6), Acute Tubular Necrosis (1), Sepsis (1), and Multifactorial (5). Nephrology was consulted on 7 patients with AKI, 6 with Stage 3 and 1 patient with Stage 1. Outpatient Nephrology follow up, readmission rates, and other long-term outcomes are in the table. All patients with Nephrology follow up were readmitted within 90-days, but there was more mortality in the No AKI group. Conclusion: Among ward based (non-ICU) patients with liver dysfunction, patients scheduled for Nephrology follow up were more likely to be readmitted. Future interventions should look to prevent readmissions while ensuring more follow-up for patients with cirrhosis and AKI. Patients with Cirrhosis with AKI status and post-discharge outcomes - Length of Stay 90-day Readmission Liver Transplant within 6 months Mortality No AKI (n=35) 7.1 (9.2) 15 (43%) 7 (9%) 2 (6%) Stage IFollow up (n=1) 4 1 (100%) 0 0 Stage I No follow up (n=9) 6.6 (3.2) 5 (55%) 3 (33%) 0 Stage II Follow up (n=1) 4 1 (100%) 0 0 Stage II No follow up (n=6) 8.8 (5.6) 4 (67%) 1 (17%) 0 Stage IIIFollow up (n=3) 19 (11) 3 (100%) 0 0 No follow up (n=4) 13 (9) 0 0 0