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Grant support

ATM received funding from the Canadian Association for the Study of Liver and the Canadian Liver Foundation. This work has been supported by the ISCIII-Subdireccion General de Evaluacion and European Regional Development Fund for the Plan Nacional I+D+I (grant number PI20/00579 to PG) .

Analysis of institutional authors

Moreta Saá, María JoséAuthorSole, CristinaAuthorJuanola, AdriaAuthorNapoleone, LauraAuthorAvitabile, EmmaAuthorPérez-Guasch, MartinaAuthorCarol MAuthorCarol, MartaAuthorGratacos-Gines, JordiAuthorSoria, AnnaAuthorRubio, Ana BelénAuthorCervera, MartaAuthorMoreta, Maria JoseAuthorMorales-Ruiz, ManuelAuthorSola, ElsaAuthorPoch, EstebanAuthorFabrellas, NuriaAuthorGraupera, IsabelAuthorPose, ElisaAuthorGines, PereCorresponding Author

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Article

Prospective validation of the EASL management algorithm for acute kidney injury in cirrhosis

Publicated to:Journal Of Hepatology. 81 (3): 441-450 - 2024-09-01 81(3), DOI: 10.1016/j.jhep.2024.03.006

Authors: Ma, AT; Juanola, A; Escudé, L; Napoleone, L; Avitabile, E; Pérez-Guasch, M; Carol, M; Pompili, E; Gratacós-Ginés, J; Soria, A; Rubio, AB; Cervera, M; Moreta, MJ; Graupera, I; Pose, E; Ginès, P; Fabrellas, N; Morales-Ruiz, M; Sola, E; Sole, C; Poch, E

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Abstract

Background & Aims: The management of acute kidney injury (AKI) in cirrhosis is challenging. The EASL guidelines proposed an algorithm for the management of AKI, but this has never been validated. We aimed to prospectively evaluate this algorithm in clinical practice. Methods: We performed a prospective cohort study in consecutive hospitalized patients with cirrhosis and AKI. The EASL management algorithm includes identification/treatment of precipitating factors, 2-day albumin infusion in patients with AKI >-stage 1B, and treatment with terlipressin in patients with hepatorenal syndrome (HRS-AKI). The primary outcome was treatment response, which included both full and partial response. Secondary outcomes were survival and adverse events associated with terlipressin therapy. Results: A total of 202 AKI episodes in 139 patients were included. Overall treatment response was 80%, while renal replacement therapy was required in only 8%. Response to albumin infusion was achieved in one-third of episodes. Of patients not responding to albumin, most (74%) did not meet the diagnostic criteria of HRS-AKI, with acute tubular necrosis (ATN) being the most common phenotype. The response rate in patients not meeting the criteria for HRS-AKI was 70%. Only 30 patients met the diagnostic criteria for HRS-AKI, and their response rate to terlipressin was 61%. Median time from AKI diagnosis to terlipressin initiation was only 2.5 days. While uNGAL (urinary neutrophil gelatinase-associated lipocalin) could differentiate ATN from other phenotypes (AUROC 0.78), it did not predict response to therapy in HRS-AKI. Ninety-day transplant-free survival was negatively associated with MELD-Na, ATN and HRS-AKI as well as uNGAL. Three patients treated with terlipressin developed pulmonary edema. Conclusions: The application of the EASL AKI algorithm is associated with very good response rates and does not significantly delay initiation of terlipressin therapy. (c) 2024 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords

Acute kidney failureAcute kidney injuryAcute kidney tubule necrosisAdultAdverse drug reactionAgedAlbuminAlbuminsAlgorithmAlgorithmsArticleAtrial fibrillationBeta adrenergic receptor blocking agentBilirubinBiomarkerBradycardiaC reactive proteinClinical evaluationClinical practiceClinical practice guidelineCohort analysisComplicationContinuous infusionControlled studyCreatinineDiagnosisDiarrheaDifferential-diagnosisDisease associationDiuretic agentDrug dose reductionDrug therapyDrug withdrawalEtiologyFemaleHeart muscle ischemiaHepatorenal syndromeHepatorenal-syndromeHospital admissionHospital patientHospitalizationHumanHumansHyponatremiaImpairmenKidney failureKidney functionLiver cirrhosisLung edemaLypressinMajor clinical studyMaleManaged careMiddle agedModel for end stage liver disease scoreMortalitMortalityNeutrophil gelatinase associated lipocalinNonsteroid antiinflammatory agentOutcome assessmentPeripheral ischemiaPractice guidelinePractice guidelines as topicProspective studiesProspective studyRenal failureRenal replacement therapySodiumTerlipressinTerlipressin plus albuminTime to treatmentTreatment indicationTreatment outcomeTreatment responseVasoconstrictor agentVasoconstrictor agents

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Hepatology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2024 there are still no calculated indicators, but in 2023, it was in position 3/143, thus managing to position itself as a Q1 (Primer Cuartil), in the category Gastroenterology & Hepatology. Notably, the journal is positioned above the 90th percentile.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2025-06-07:

  • WoS: 2
  • Scopus: 10

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-07:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 34.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 23 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 23.05.
  • The number of mentions on the social network X (formerly Twitter): 36 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Canada; United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: Last Author (Ginès Gibert, Pere).

the author responsible for correspondence tasks has been Ginès Gibert, Pere.