To Develop and Validate an Equation for Determination of Major Adverse Kidney Events in Patients With Decompensated Cirrhosis and Ascites.

To Develop and Validate an Equation for Determination of Major Adverse Kidney Events in Patients With Decompensated Cirrhosis and Ascites- A Prospective Cohort Study

Acute kidney injury (AKI) is the sudden loss of kidney function that occurs frequently in hospitalised patients with cirrhosis.

• It develops in up to 53% and is independently associated with high short-term mortality.
• A diagnosis of AKI (even stage 1 AKI) has been shown to be associated with an increased risk of long-term mortality at 30-day, 90-day and 1-year, compared to patients without AKI, even when there is recovery of AKI.
• Risk factors with the strongest association for developing AKI include CKD, sepsis, spontaneous bacterial peritonitis (SBP), and presence of ascites.
• AKI in cirrhosis is also associated with development of de-novo chronic kidney disease (CKD) , progressive loss of kidney function in patients with pre-existing CKD,recurrent AKI (i.e., AKI on top of CKD) and other organ failures
• Kidney dysfunction in patients with cirrhosis is associated with a marked increase in mortality compared with patients without kidney dysfunction.
• The accurate estimation of kidney function in patients with cirrhosis is hence crucial for prognosis, treatment strategies, and decisions regarding simultaneous liver-kidney transplantation (SLKT).
• Although measured GFR(mGFR) may be ideal for assessing kidney function, it is costly, time-consuming, and challenging to perform frequently in fluctuating kidney function. Therefore, GFR is most commonly estimated using serum creatinine (sCr)-based or cystatin C (CysC)-based equations

Inclusion Criteria:

1. Patients of cirrhosis with ascites with stable renal functions in last 7 days (variability in gfr < 15 % and no AKI).

Exclusion Criteria:

1. Patients with age <18 or more than 65 years
2. Obstructive uropathy or intrinsic kidney disease
3. Patients with multiorgan failure or requiring mechanical ventilation
4. Patients who had previously undergone Liver or Kidney transplant
5. Patients with missing laboratory measurements within 24 hours of admission
6. HCC
7. Pregnant
8. Lack of baseline serum creatinine
9. Need of renal replacement therapy
10. HVOTO
11. Severe comorbid cardiopulmonary diseases or extrahepatic malignancy