Association Between Hypotension and AKI in Hospitalized Patients with Cirrhosis

Background: AKI is a frequent complication in cirrhotic patients. Hypotension, another common complication of cirrhosis, poses unique management challenges in hospitalized patients. Blood pressure goals for those with cirrhosis are extrapolated from other populations. The relationship between hypotension, and the incidence of AKI remains poorly elucidated in the inpatient setting. Here, we examine the association between hypotension, vasopressor use, and the development of AKI in patients with cirrhosis admitted to the hospital. Methods: A retrospective cohort study of adult patients with diagnosis of cirrhosis admitted to a tertiary medical center between Feb 2011 and Dec 2023. AKI was defined according to the AKIN criteria, while hypotension was defined as a mean arterial blood pressure (MAP) < 65 mmHg. Results: A total of 6539 patients with cirrhosis were included. Median age 57.9 years [IQR 47.7-65.7], 43.8% female (n=2864). Median MELD-Na score 13.54 [6.89-24.58]). 31.33% spent time in the ICU (n=2049), and 13.64% received vasopressors (n=892). Median length of stay 5 days [3-10]. AKI occurred in 29.6% of patients (n=1935): AKIN-1 17.5% (n=1174), AKIN-2 6% (n=391), and AKIN-3 5.7% (n=370) with 8.3% (n=541) requiring hemodialysis during their hospitalization. Hypotension occurred in 51.7% of patients (n=3373). Thirty-day, ninety-day, and one-year mortality was 0.23, 0.36, and 0.53 respectively. Hypotension was strongly associated with AKI (OR 5, p<0.001). Hypotension was associated with a higher mortality rate even when adjusted to age (OR 1.58, p<0.001). Conclusion: AKI is a highly prevalent complication among hospitalized patients with cirrhosis. The presence of hypotension strongly correlates with AKI, and is associated with increased mortality. Future prospective studies are essential to identify therapeutic targets and improve outcomes.