S2773 Demographic and Temporal Patterns of Mortality in Acute Kidney Injury Among Patients With Liver Cirrhosis: A 22-Year Analysis Using the CDC WONDER Database

Introduction: Acute kidney injury (AKI), which includes hepatorenal syndrome (HRS), complicates approximately 20% of cirrhosis hospitalizations and significantly increases mortality. While HRS is a well-recognized and severe form of AKI in cirrhosis, AKI encompasses a broader spectrum, including prerenal azotemia, acute tubular necrosis, and other etiologies that must first be ruled out before diagnosing HRS. Despite prior studies on AKI in cirrhosis, temporal trends and demographic disparities in AKI-related mortality remain underexplored. We aimed to assess trends over 22 years in AKI-related mortality among cirrhotic patients using CDC WONDER, stratified by age, sex, race, and region. Methods: A retrospective analysis was performed using the CDC WONDER data (1999-2020) to identify cirrhosis-related deaths with concurrent AKI. Age-adjusted mortality rates (AAMRs) per 1,000,000 were calculated. Temporal trends in AAMR were analyzed using Joinpoint regression and stratified by gender, race, region, and age group. Results: Between 1999 and 2020, 37,460 deaths were attributed to cirrhosis with AKI in the U.S. Overall AAMR increased significantly, with an APC of 3.81 (P-value < 0.000001). Women observed a mortality decline from 2015–2020 compared to 1999–2015 (APC: 3.48 vs 5.17), but it remained higher than in men (APC: 3.13). Whites showed the highest increase in AAMR (APC: 4.17), followed by Hispanics and Blacks. The AAMR showed a significant upward trend in all age groups, with the 35–44 age group recording the highest AAMR post-2015 (APC: 11.33). Region-wise analysis showed a steady upward trend for all regions except the Northeast, which showed a sharp increase from 2018–2020 as compared to 1999–2018 (APC: 10.35 vs 1.22). Conclusion: While HRS remains a leading cause of death among patients with cirrhosis, our study evaluated the broader category of AKI-related mortality, which includes but is not limited to HRS. The overall mortality rates for AKI in cirrhosis have steadily risen since 1999, with striking increases among younger adults and White, Hispanic, and Black populations. These findings highlight the importance of early identification, prevention strategies, and targeted intervention in these high-risk groups. Further studies are needed to investigate the underlying causes of these disparities and trends.