Albumin creatinine ratio predicts medical intensive care unit outcome of patients with hepatic encephalopathy

Background and Aims: Hepatic encephalopathy (HE) in a hospitalized cirrhotic patient is associated with a high mortality rate, unless treated; the 1 st year survival is 42%. Increasing evidence has indicated that in patients with cirrhosis, proteinuria is associated with reduced survival compared with patients without proteinuria. We attempted to explore the prognostic role of proteinuria in patients with hepatic encephalopathy admitted to medical intensive care unit (MICU).

Methods: 78 consecutive cirrhotic patients with HE admitted to MICU included. Patient's demographics, HE grade, ChildPugh class, SOFA score, MELD score and albumin/creatinine ratio (ACR) were documented at the 1 st day of MICU admission for all patients. MICU mortality, the occurrence of acute kidney injury (AKI) and respiratory failure during MICU admission also recorded.

Results: Among 78 cirrhotic patients with HE (39 females, and 39 males), There mean age was 57.65 ± 12.9 years. HE grades 0, I, II, III, and IV detected among 0, 0, 16 (20.5%), 44 (56.4%) and 18 (23%) patients respectively. 0, 12 (15.4%) and 66 (84.6%) patients had Child classes A, B and C respectively. The mean MELD and SOFA scores were 17.97 ± 6.36 and 6.89 ± 2.71respectively. In addition the mean ACR among included patients was 109.54 ± 138.48 µg/dl. The mean MICU stay of all patients was 4.78 ± 2.81 days. MICU mortality rate was 32% (n = 25). 23 (29.5%), and 7 (9%) patients developed AKI and respiratory failure, during MICU stay, respectively. ACR > 57 µg/dl was the best cut-off value for prediction of MICU mortality. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ACR > 57 µg/dl, for prediction of MICU mortality was 83%, 76%, and 75.5%, 59.4% and 87% respectively. Interestingly ACR perfectly discloses patients with pre-renal AKI from those with of AKI due to renal causes.

Conclusions: ACR is a promising Predictor of prognosis in patients with HE. In addition it can be used as early marker of AKI due intrinsic kidney disease in HE patients admitted to MICU.

Keyword: Prognosis of hepatic encephalopathy in MICU