Both AKI Stage 1A and 1B Increase Mortality in Cirrhosis, suggests study

Systematic review used a strict search on PubMed, Cochrane Library, EMBASE, Scopus, and Chinese National Knowledge Infrastructure (CNKI) databases. Studies of AKI stage 1A vs. stage 1B and no AKI (NAKI) were included.

A total of 11 studies were included, with the following:

• 2,647 patients with AKI stage 1A

• 3,052 patients with AKI stage 1B

• 1,395 patients with no AKI

Key Findings

Prevalence:

• AKI stage 1A prevalence: 16.3% (95% CI: 11.3–22.9%)

• AKI stage 1B prevalence: 15.7% (95% CI: 9.3–25.3%)

Risk of mortality in comparison to no AKI (NAKI):

•  Stage 1A: 2-fold increase (OR: 1.98, 95% CI: 1.33–2.97, P=0.004)

• Stage 1B: 4.8-fold increase (OR: 4.79, 95% CI: 3.30–6.95, P<0.001)

Risk of mortality in comparison to stage 1A:

• Stage 1B increased the risk of mortality by an additional 1.6 times (OR: 1.55, 95% CI: 1.03–2.31, P<0.001).

This meta-analysis of 11 studies involving more than 7,000 patients presents strong evidence that both AKI stages 1A and 1B independently increase mortality risk in cirrhosis. With incidence rates of approximately one in six patients, AKI is prevalent, and even its mildest level almost doubles the risk of death. Stage 1B further deteriorates outcomes, risk nearly fivefold higher. Clinicians should pursue early identification and active management of all AKI stages in cirrhotic patients.

Reference:

Wan, Y.-M., Wu, H.-M., Li, Y.-H., Huang, S.-Q., Yin, H.-J., & Xu, Y. (2025). The mortality risk of acute kidney injury stage 1A and 1B in cirrhosis: A systematic review and meta-analysis. Journal of Clinical and Experimental Hepatology, 103154, 103154. https://doi.org/10.1016/j.jceh.2025.103154