Adaptive Bayesian Analysis Personal Reference Ranges of Serum Creatinine and Urea for the Prediction of Acute Kidney Injury in Cirrhosis.
AASLD LiverLearning®. Patidar K. Nov 14, 2016; 144960
Label: Portal Hypertension: Ascites, Renal Dysfunction, and Hepatorenal Syndrome
Kavish Patidar
Kavish Patidar
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ABSTRACT FINAL ID: 2068

TITLE: Adaptive Bayesian Analysis Personal Reference Ranges of Serum Creatinine and Urea for the Prediction of Acute Kidney Injury in Cirrhosis.

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ABSTRACT BODY:
Background
Acute kidney Injury (AKI) contributes to significant morbidity and mortality in cirrhotic patients. Serum creatinine (Scr) and blood urea nitrogen (BUN) are practical biomarkers of renal function that could predict AKI. However, these markers may underestimate renal impairment in patients with cirrhosis, and thus baseline Scr values within the normal reference ranges (RR) cannot reliably exclude significant impairment in renal function. Furthermore, small changes in these biomarkers are often perceived as lab variability or measurement bias that could obviate the recognition of decrement in renal function.

Aim
To determine the performance characteristics of a validated statistical model, the Adaptive Bayesian Analysis Model (ABAM), which derives individually-based Scr and BUN RRs in predicting AKI in a cirrhotic patient.

Methods
40 cirrhotics (56 yrs, 55% men, 45% HCV, CTP 9, 63% ascites, 83% on diuretics) who were admitted for AKI (defined by the International Ascites Club criteria) were retrospectively analyzed. Scr and BUN determinations from 2 or 3 clinic visits prior hospitalization for AKI was systematically assessed for each subject using ABAM. Individual Scr and BUN RRs was determined at a specificity of 99% and compared with group RRs stratified by gender.

Results
Average time between visits and last visit to hospitalization was 65 days (range 32-485 days) and 52 days (range 5-188 days) respectively. The major etiology for AKI was pre-renal azotemia at 80%. Before admission, 35% (14/40) had at least one value out of the group RR. This number increased to 65% (26/40) when individual ABAM RR were used for prediction for AKI. Furthermore, of the 30 patients who presented a normal value at their first visit, only 13% (4/30) had a subsequent value out of the group RR, while 47% (14/30) of them had values out of the RRs when using the individual ABAM RR.

Conclusions
ABAM is able to accurately adjudicate individual RRs for Scr and is more sensitive than group RRs in predicting early phases of AKI. Early identification and management of cirrhotic patients with Scr values upper limit of their individual RR could prevent admissions.

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