{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T20:09:37Z","timestamp":1790539777750,"version":"4.1.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>Acute kidney injury (AKI) has a poor prognosis in cirrhosis. Given the variability of creatinine, the prediction of AKI and dialysis by other markers is needed. The aim of this study is to determine the role of serum and urine metabolomics in the prediction of AKI and dialysis in an inpatient cirrhosis cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>Inpatients with cirrhosis from 11 North American Consortium of End\u2010stage Liver Disease centers who provided admission serum\/urine when they were AKI and dialysis\u2010free were included. Analysis of covariance adjusted for demographics, infection, and cirrhosis severity was performed to identify metabolites that differed among patients (1) who developed AKI or not; (2) required dialysis or not; and\/pr (3) within AKI subgroups who needed dialysis or not. We performed random forest and AUC analyses to identify specific metabolite(s) associated with outcomes. Logistic regression with clinical variables with\/without metabolites was performed. A total of 602 patients gave serum (218 developed AKI, 80 needed dialysis) and 435 gave urine (164 developed AKI, 61 needed dialysis). For AKI prediction, clinical factor\u2013adjusted AUC was 0.91 for serum and 0.88 for urine. Major metabolites such as uremic toxins (2,3\u2010dihydroxy\u20105\u2010methylthio\u20104\u2010pentenoic acid [DMTPA], N2N2dimethylguanosine, uridine\/pseudouridine) and tryptophan\/tyrosine metabolites (kynunerate, 8\u2010methoxykyunerate, quinolinate) were higher in patients who developed AKI. For dialysis prediction, clinical factor\u2013adjusted AUC was 0.93 for serum and 0.91 for urine. Similar metabolites as AKI were altered here. For dialysis prediction in those with AKI, the AUC was 0.81 and 0.79 for serum\/urine. Lower branched\u2010chain amino\u2010acid (BCAA) metabolites but higher cysteine, tryptophan, glutamate, and DMTPA were seen in patients with AKI needing dialysis. Serum\/urine metabolites were additive to clinical variables for all outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Specific admission urinary and serum metabolites were significantly additive to clinical variables to predict AKI development and dialysis initiation in inpatients with cirrhosis. These observations can potentially facilitate earlier initiation of renoprotective measures.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.31907","type":"journal-article","created":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T05:09:07Z","timestamp":1621314547000},"page":"2699-2713","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":46,"title":["Admission Urinary and Serum Metabolites Predict Renal Outcomes in Hospitalized Patients With Cirrhosis"],"prefix":"10.1097","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-3681","authenticated-orcid":false,"given":"Jasmohan S.","family":"Bajaj","sequence":"first","affiliation":[{"name":"Virginia Commonwealth University and Central Virginia Veterans Healthcare System,Richmond,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guadalupe","family":"Garcia\u2010Tsao","sequence":"additional","affiliation":[{"name":"Yale University Medical Center,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4898-7778","authenticated-orcid":false,"given":"K. Rajender","family":"Reddy","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Medical Center,Philadelphia,PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline G.","family":"O\u2019Leary","sequence":"additional","affiliation":[{"name":"Dallas Veterans Affairs Medical Center,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7802-688X","authenticated-orcid":false,"given":"Hugo E.","family":"Vargas","sequence":"additional","affiliation":[{"name":"Mayo Clinic Arizona,Phoenix,AR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer C.","family":"Lai","sequence":"additional","affiliation":[{"name":"University of California, San Francisco,San Francisco,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick S.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Mayo Clinic Rochester,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puneeta","family":"Tandon","sequence":"additional","affiliation":[{"name":"University of Alberta,Edmonton,AB,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ram M.","family":"Subramanian","sequence":"additional","affiliation":[{"name":"Emory University,Atlanta,GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Thuluvath","sequence":"additional","affiliation":[{"name":"Mercy Medical Center,Baltimore,MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Fagan","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University and Central Virginia Veterans Healthcare System,Richmond,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7346-5683","authenticated-orcid":false,"given":"Tejasav","family":"Sehrawat","sequence":"additional","affiliation":[{"name":"Mayo Clinic Rochester,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randolph","family":"de la Rosa Rodriguez","sequence":"additional","affiliation":[{"name":"Yale University Medical Center,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leroy R.","family":"Thacker","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University and Central Virginia Veterans Healthcare System,Richmond,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9263-8869","authenticated-orcid":false,"given":"Florence","family":"Wong","sequence":"additional","affiliation":[{"name":"University of 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