Korean J Gastroenterol.  2010 Dec;56(6):359-364. 10.4166/kjg.2010.56.6.359.

Clinical Features and Predictive Factors of Acute Hepatitis A Complicated with Acute Kidney Injury

• Lee JH
• Choi MS
• Gwak GY
• Lee JH
• Koh KC
• Paik SW
• Yoo BC

• KMID: 1775851
• DOI: http://doi.org/10.4166/kjg.2010.56.6.359

Abstract

BACKGROUND/AIMS
We assessed the clinical features and prognosis of acute viral hepatitis A (AHA) complicated with acute kidney injury (AKI) and elucidated predictive factors for AKI in patients with AHA.
METHODS
We reviewed medical record of 391 patients with AHA admitted at our institution since 2000.
RESULTS
AKI was present in 45 patients (11.5%). The proportion of the AKI group increased since 2008 (5.4% before 2008 vs. 15.9% since 2008, p=0.001). The AKI group was older than the non-AKI group (35.7+/-8.7 years vs. 31.3+/-7.8 years, p=0.002). Other baseline clinical characteristics were similar between two groups. Initial hemoglobin, platelet, and serum albumin were significantly low and prothrombin time, serum bilirubin, creatinine, AST, and ALT were significantly high in the AKI group. Hepatic encephalopathy, ascites, gastrointestinal bleeding, and sepsis were more frequently observed in the AKI group. While six patients (13%) in the AKI group received liver transplantation (LT) but three patients died within one month, one patient in the non-AKI group receiving LT is alive. Multivariate analysis showed that older age (OR 1.07, 95% CI 1.02-1.12), initial thrombocytopenia <150,000/mm2 (OR 2.85, 95% CI 1.24-6.57), prothrombin time (PT) prolongation (OR 5.34, 95% CI 2.55-11.19), and hypoalbuminemia (OR 8.24, 95% CI 2.53-26.86) were independently associated with the occurrence of AKI.
CONCLUSIONS
AHA with AKI is an increasing problem showing significant morbidity and mortality in Korea. AKI is highly associated with older age, initial thrombocytopenia, PT prolongation, or low serum albumin, and has bad prognostic effect.

Keyword

Acute kidney injury; Hepatitis A; Survival; Transplantation

MeSH Terms

Acute Disease
Acute Kidney Injury/complications/*diagnosis/therapy
Adult
Age Factors
Alanine Transaminase/blood
Aspartate Aminotransferases/blood
Bilirubin/blood
Creatine/blood
Female
Hemoglobins/analysis
Hepatitis A/complications/*diagnosis
Humans
Hypoalbuminemia/complications
Liver Transplantation
Male
Middle Aged
Odds Ratio
Platelet Count
Predictive Value of Tests
Prognosis
Prothrombin Time
Serum Albumin/analysis
Thrombocytopenia/complications

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