In severe alcohol-related hepatitis, acute kidney injury is prevalent, associated with mortality independent of liver disease severity, and can be predicted using IL-8 and micro-RNAs

Background
The prevalence, prediction, and impact of acute kidney injury (AKI) in alcohol-related hepatitis (AH) is uncertain.
Aims
We aimed to determine AKI incidence; association with mortality; evaluate serum biomarkers; and the modifying effects of prednisolone and pentoxifylline in the largest AH cohort to date.
Methods
Participants in the Steroids or Pentoxifylline for Alcoholic Hepatitis trial with day zero (D0) creatinine available were included. AKI was defined by modified International Club of Ascites criteria; incident AKI as day 7 (D7) AKI without D0-AKI. Survival was compared by Kaplan-Meier; mortality associations by Cox regression; associations with AKI by binary logistic regression; biomarkers by AUROC analyses.
Results
D0-AKI was present in 198/1051 (19%) participants; incident AKI developed in a further 119/571 (21%) with available data. Participants with D0-AKI had higher 90-day mortality than those without (32% vs 25%, P =0.008), as did participants with incident AKI compared to those without D0-AKI or incident AKI (47% vs 25%, P <0.001). Incident AKI associated with D90 mortality adjusted for age and discriminant function (AHR 2.15, 1.56-2.97, P <0.001); D0-AKI did not. Prednisolone therapy reduced incident AKI (AOR 0.55, 0.36-0.85, P =0.007) but not mortality. D0 bilirubin and IL-8 combined, miR-6826-5p, and miR-6811-3p predicted incident AKI (AUROCs 0.726, 0.821, 0.770, P <0.01).
Conclusions
Incident AKI associated with 90-day mortality independent of liver function. Prednisolone therapy was associated with reduced incident AKI. IL-8 and several miRNAs are potential biomarkers to predict AKI. Novel therapies to prevent incident AKI should be evaluated in AH to reduce mortality.