#3004 INCIDENCE, RISK FACTORS, AND OUTCOMES OF ACUTE LIVER INJURY IN HOSPITALIZED ADULTS WITH ACUTE KIDNEY INJURY: A LARGE MULTICENTER STUDY

Abstract Background and Aims Acute kidney injury (AKI) and acute liver injury (ALI) were associated with poor outcomes during hospitalization, respectively. However, the clinical outcome of AKI combined with ALI (AKI-ALI) was still remains unknown. The current study was aimed to describe the incidences, risk factors, and outcomes of AKI-ALI. Method The study population included AKI patients aged 18–99 years with enough serum creatinine testing and liver function testing (LFT) hospitalized at 19 medical centers throughout China between 2000 and 2021. AKI was defined by Kidney Disease Improving Global Outcomes and ALI was defined by the change of liver enzymes based on Asia Pacific Association of Study of Liver consensus guidelines. The Cox proportional hazards model was used to identify risk factors for AKI-ALI, and a time-dependent Cox proportional hazards regression model was used to estimate the association between AKI-ALI and in-hospital mortality. Results Among the 18461 patients with AKI (median [Interquartile Range, IQR] age, 65.71 [52.78, 76.36] years, 9725 (52.7%) males), ALI occurred in 1689 (9.1%) patients. Patients with AKI who were male, have used drugs including antibiotics, diabetes agents, diuretics, glucocorticoids, immunosuppressants, nonsteroidal anti-inflammatory drugs or vasopressors, with heart failure, respiratory failure, malignant tumor or shock, have lower platelets levels, higher aspartate aminotransferase levels or higher glutamyl transpeptidase levels at baseline, have received general surgery or thoracic surgery were associated with higher risk of AKI-ALI. Patients with AKI-ALI had longer length of hospital stay and were associated with a higher risk of in-hospitalized mortality (Hazard ratio [95% Confidence Interval] 1.51, [1.33, 1.72]) compared with patients with AKI but without ALI. In addition, a stronger association between AKI-ALI and in-hospital mortality was found in those with lower AKI grades (P for interaction = 0.036). Conclusion ALI was common among patients with AKI and AKI-ALI was associated with an increased risk of in-hospital mortality. This study suggests interventions for liver function early to improve in-hospital prognosis of patients with AKI.