{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T01:59:11Z","timestamp":1776995951673,"version":"3.51.4"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2016,3,17]],"date-time":"2016-03-17T00:00:00Z","timestamp":1458172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2016,3,17]],"date-time":"2016-03-17T00:00:00Z","timestamp":1458172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Critically ill cirrhotic patients have high mortality rates, particularly when they present with acute kidney injury (AKI) on admission. The Kidney Disease: Improving Global Outcomes (KDIGO) group aimed to standardize the definition of AKI and recently published a new AKI classification. However, the efficacy of the KDIGO classification for predicting outcomes of critically ill cirrhotic patients is unclear. We prospectively enrolled 242 cirrhotic patients from a 10-bed specialized hepatogastroenterology intensive care unit (ICU) in a 2000-bed tertiary-care referral hospital. Demographic parameters and clinical variables on day 1 of admission were prospectively recorded. The overall in-hospital mortality rate was 62.8%. Liver diseases were usually attributed to hepatitis B viral infection (26.9%). The major cause of ICU admission was upper gastrointestinal bleeding (38.0%). Our result showed that the KDIGO classification had better discriminatory power than RIFLE and AKIN criteria in predicting in-hospital mortality. Cumulative survival rates at the 6-month after hospital discharge differed significantly between patients with and without AKI on ICU admission day. In summary, we identified that the outcome prediction performance of KDIGO classification is superior to that of AKIN or RIFLE classification in critically ill cirrhotic patients.<\/jats:p>","DOI":"10.1038\/srep23022","type":"journal-article","created":{"date-parts":[[2016,3,17]],"date-time":"2016-03-17T11:29:14Z","timestamp":1458214154000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Acute Kidney Injury Classification for Critically Ill Cirrhotic Patients: A Comparison of the KDIGO, AKIN and RIFLE Classifications"],"prefix":"10.1038","volume":"6","author":[{"given":"Heng-Chih","family":"Pan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Shan","family":"Chien","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang-Chyi","family":"Jenq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Hung","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pei-Chun","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Hsiang","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Yang","family":"Chang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya-Chung","family":"Tian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji-Tseng","family":"Fang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chih-Wei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yung-Chang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2016,3,17]]},"reference":[{"key":"BFsrep23022_CR1","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1001\/jama.294.7.813","volume":"294","author":"S Uchino","year":"2005","unstructured":"Uchino, S. et al. Acute renal failure in critically ill patients. JAMA: the journal of the American Medical Association 294, 813 (2005).","journal-title":"JAMA: the journal of the American Medical Association"},{"key":"BFsrep23022_CR2","doi-asserted-by":"publisher","first-page":"1837","DOI":"10.1097\/01.CCM.0000277041.13090.0A","volume":"35","author":"M Ostermann","year":"2007","unstructured":"Ostermann, M. & Chang, R. W. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 35, 1837\u20131843 (2007).","journal-title":"Crit Care Med"},{"key":"BFsrep23022_CR3","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1002\/hep.22605","volume":"48","author":"G Garcia\u2010Tsao","year":"2008","unstructured":"Garcia\u2010Tsao, G., Parikh, C. R. & Viola, A. Acute kidney injury in cirrhosis. Hepatology 48, 2064\u20132077 (2008).","journal-title":"Hepatology"},{"key":"BFsrep23022_CR4","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1056\/NEJMra0809139","volume":"361","author":"P Gin\u00e8s","year":"2009","unstructured":"Gin\u00e8s, P. & Schrier, R. W. Renal failure in cirrhosis. New England Journal of Medicine 361, 1279\u20131290 (2009).","journal-title":"New England Journal of Medicine"},{"key":"BFsrep23022_CR5","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1111\/j.1440-1746.2009.05908.x","volume":"24","author":"E Cholongitas","year":"2009","unstructured":"Cholongitas, E. et al. RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unit. Journal of gastroenterology and hepatology 24, 1639\u20131647 (2009).","journal-title":"Journal of gastroenterology and hepatology"},{"key":"BFsrep23022_CR6","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1136\/gut.2010.236133","volume":"60","author":"F Wong","year":"2011","unstructured":"Wong, F. et al. Working Party proposal for a revised classification system of renal dysfunction in patients with cirrhosis. Gut 60, 702\u2013709 (2011).","journal-title":"Gut"},{"key":"BFsrep23022_CR7","first-page":"7","volume":"7","author":"HC Pan","year":"2012","unstructured":"Pan, H. C. et al. Risk models and scoring systems for predicting the prognosis in critically ill cirrhotic patients with acute kidney injury: a prospective validation study. PLoS One 7, 7 (2012).","journal-title":"PLoS One"},{"key":"BFsrep23022_CR8","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1111\/apt.12299","volume":"37","author":"AJ Slack","year":"2013","unstructured":"Slack, A. J. et al. Predicting the development of acute kidney injury in liver cirrhosis \u2013 an analysis of glomerular filtration rate, proteinuria and kidney injury biomarkers. Alimentary pharmacology & therapeutics 37, 989\u2013997, doi: 10.1111\/apt.12299 (2013).","journal-title":"Alimentary pharmacology & therapeutics"},{"key":"BFsrep23022_CR9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1159\/000339789","volume":"120","author":"A Khwaja","year":"2012","unstructured":"Khwaja, A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120, 7 (2012).","journal-title":"Nephron Clin Pract"},{"key":"BFsrep23022_CR10","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/j.jcrc.2012.12.008","volume":"28","author":"AJ Bastin","year":"2013","unstructured":"Bastin, A. J. et al. Acute kidney injury after cardiac surgery according to Risk\/Injury\/Failure\/Loss\/End-stage, Acute Kidney Injury Network and Kidney Disease: Improving Global Outcomes classifications. J Crit Care 28, 389\u2013396 (2013).","journal-title":"J Crit Care"},{"key":"BFsrep23022_CR11","doi-asserted-by":"publisher","first-page":"12","DOI":"10.2215\/CJN.02730313","volume":"9","author":"X Zeng","year":"2014","unstructured":"Zeng, X., McMahon, G. M., Brunelli, S. M., Bates, D. W. & Waikar, S. S. Incidence, outcomes and comparisons across definitions of AKI in hospitalized individuals. Clin J Am Soc Nephrol 9, 12\u201320 (2014).","journal-title":"Clin J Am Soc Nephrol"},{"key":"BFsrep23022_CR12","doi-asserted-by":"publisher","first-page":"848","DOI":"10.2215\/CJN.09530913","volume":"9","author":"T Fujii","year":"2014","unstructured":"Fujii, T., Uchino, S., Takinami, M. & Bellomo, R. Validation of the Kidney Disease Improving Global Outcomes criteria for AKI and comparison of three criteria in hospitalized patients. Clin J Am Soc Nephrol 9, 848\u2013854 (2014).","journal-title":"Clin J Am Soc Nephrol"},{"key":"BFsrep23022_CR13","first-page":"299","volume":"29","author":"MN Machado","year":"2014","unstructured":"Machado, M. N., Nakazone, M. A. & Maia, L. N. Acute kidney injury based on KDIGO (Kidney Disease Improving Global Outcomes) criteria in patients with elevated baseline serum creatinine undergoing cardiac surgery. Rev Bras Cir Cardiovasc 29, 299\u2013307 (2014).","journal-title":"Rev Bras Cir Cardiovasc"},{"key":"BFsrep23022_CR14","doi-asserted-by":"publisher","first-page":"R144","DOI":"10.1186\/cc13977","volume":"18","author":"X Luo","year":"2014","unstructured":"Luo, X. et al. A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Critical care (London, England) 18, R144, doi: 10.1186\/cc13977 (2014).","journal-title":"Critical care (London, England)"},{"key":"BFsrep23022_CR15","first-page":"12953","volume":"11","author":"HC Pan","year":"2014","unstructured":"Pan, H. C. et al. Scoring systems for 6-month mortality in critically ill cirrhotic patients: a prospective analysis of chronic liver failure-sequential organ failure assessment score (CLIF-SOFA). Aliment Pharmacol Ther 11, 12953 (2014).","journal-title":"Aliment Pharmacol Ther"},{"key":"BFsrep23022_CR16","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1186\/s13054-014-0700-0","volume":"18","author":"A C\u00e1rdenas","year":"2014","unstructured":"C\u00e1rdenas, A. et al. Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study. Critical care 18, 700 (2014).","journal-title":"Critical care"},{"key":"BFsrep23022_CR17","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1002\/lt.22128","volume":"16","author":"C Francoz","year":"2010","unstructured":"Francoz, C. et al. Inaccuracies of creatinine and creatinine-based equations in candidates for liver transplantation with low creatinine: impact on the model for end-stage liver disease score. Liver transplantation: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 16, 1169\u20131177, doi: 10.1002\/lt.22128 (2010).","journal-title":"Liver transplantation: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society"},{"key":"BFsrep23022_CR18","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1016\/j.jhep.2014.12.029","volume":"62","author":"P Angeli","year":"2015","unstructured":"Angeli, P. et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. J Hepatol 62, 968\u2013974 (2015).","journal-title":"J Hepatol"},{"key":"BFsrep23022_CR19","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.jhep.2013.04.036","volume":"59","author":"C Fagundes","year":"2013","unstructured":"Fagundes, C. et al. A modified acute kidney injury classification for diagnosis and risk stratification of impairment of kidney function in cirrhosis. J Hepatol 59, 474\u2013481 (2013).","journal-title":"J Hepatol"},{"key":"BFsrep23022_CR20","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1136\/gutjnl-2011-301255","volume":"62","author":"CD Tsien","year":"2013","unstructured":"Tsien, C. D., Rabie, R. & Wong, F. Acute kidney injury in decompensated cirrhosis. Gut 62, 131\u2013137 (2013).","journal-title":"Gut"},{"key":"BFsrep23022_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/000456328602300101","volume":"23","author":"K Spencer","year":"1986","unstructured":"Spencer, K. Analytical reviews in clinical biochemistry: the estimation of creatinine. Ann Clin Biochem 23, 1\u201325 (1986).","journal-title":"Ann Clin Biochem"},{"key":"BFsrep23022_CR22","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1001\/archinte.1994.00420020117013","volume":"154","author":"L Caregaro","year":"1994","unstructured":"Caregaro, L. et al. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis. Arch Intern Med 154, 201\u2013205 (1994).","journal-title":"Arch Intern Med"},{"key":"BFsrep23022_CR23","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1053\/ajkd.2003.50035","volume":"41","author":"DS Sherman","year":"2003","unstructured":"Sherman, D. S., Fish, D. N. & Teitelbaum, I. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis 41, 269\u2013278 (2003).","journal-title":"Am J Kidney Dis"},{"key":"BFsrep23022_CR24","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/cc8855","volume":"14","author":"A Slack","year":"2010","unstructured":"Slack, A., Yeoman, A. & Wendon, J. Renal dysfunction in chronic liver disease. Crit Care 14, 9 (2010).","journal-title":"Crit Care"},{"key":"BFsrep23022_CR25","doi-asserted-by":"publisher","first-page":"3365","DOI":"10.1681\/ASN.2004090740","volume":"16","author":"GM Chertow","year":"2005","unstructured":"Chertow, G. M., Burdick, E., Honour, M., Bonventre, J. V. & Bates, D. W. Acute kidney injury, mortality, length of stay and costs in hospitalized patients. J Am Soc Nephrol 16, 3365\u20133370 (2005).","journal-title":"J Am Soc Nephrol"},{"key":"BFsrep23022_CR26","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1001\/archinte.168.6.609","volume":"168","author":"BB Newsome","year":"2008","unstructured":"Newsome, B. B. et al. Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction. Arch Intern Med 168, 609\u2013616 (2008).","journal-title":"Arch Intern Med"},{"key":"BFsrep23022_CR27","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1681\/ASN.2008070669","volume":"20","author":"SS Waikar","year":"2009","unstructured":"Waikar, S. S. & Bonventre, J. V. Creatinine kinetics and the definition of acute kidney injury. Journal of the American Society of Nephrology 20, 672\u2013679 (2009).","journal-title":"Journal of the American Society of Nephrology"},{"key":"BFsrep23022_CR28","doi-asserted-by":"publisher","first-page":"e484","DOI":"10.1053\/j.gastro.2010.07.043","volume":"140","author":"M Mart\u00edn\u2013Llah\u00ed","year":"2011","unstructured":"Mart\u00edn\u2013Llah\u00ed, M. et al. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology 140, 488-496. e484 (2011).","journal-title":"Gastroenterology"},{"key":"BFsrep23022_CR29","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1007\/s00134-007-0760-6","volume":"33","author":"CC Jenq","year":"2007","unstructured":"Jenq, C. C. et al. RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients. Intensive Care Med 33, 1921\u20131930 (2007).","journal-title":"Intensive Care Med"},{"key":"BFsrep23022_CR30","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.1016\/j.athoracsur.2007.05.045","volume":"84","author":"CY Lin","year":"2007","unstructured":"Lin, C. Y. et al. Evaluation of outcome scoring systems for patients on extracorporeal membrane oxygenation. Ann Thorac Surg 84, 1256\u20131262 (2007).","journal-title":"Ann Thorac Surg"},{"key":"BFsrep23022_CR31","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1097\/00003246-199005000-00002","volume":"18","author":"DD Tran","year":"1990","unstructured":"Tran, D. D. et al. Age, chronic disease, sepsis, organ system failure and mortality in a medical intensive care unit. Crit Care Med 18, 474\u2013479 (1990).","journal-title":"Crit Care Med"},{"key":"BFsrep23022_CR32","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1378\/chest.100.6.1619","volume":"100","author":"WA Knaus","year":"1991","unstructured":"Knaus, W. A. et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100, 1619\u20131636 (1991).","journal-title":"Chest"},{"key":"BFsrep23022_CR33","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1097\/00004836-200309000-00011","volume":"37","author":"MH Tsai","year":"2003","unstructured":"Tsai, M. H. et al. Organ system failure scoring system can predict hospital mortality in critically ill cirrhotic patients. Journal of clinical gastroenterology 37, 251 (2003).","journal-title":"Journal of clinical gastroenterology"},{"key":"BFsrep23022_CR34","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1097\/00003246-199206000-00025","volume":"20","author":"RC Bone","year":"1992","unstructured":"Bone, R. C. et al. American-college of chest physicians society of critical care medicine consensus conference-definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Critical care medicine 20, 864\u2013874 (1992).","journal-title":"Critical care medicine"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/srep23022","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep23022.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep23022.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T13:05:01Z","timestamp":1672837501000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/srep23022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,3,17]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,9,2]]}},"alternative-id":["BFsrep23022"],"URL":"https:\/\/doi.org\/10.1038\/srep23022","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,3,17]]},"assertion":[{"value":"20 November 2015","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 February 2016","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2016","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing financial interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"23022"}}