Background: Acute kidney injury (AKI) is a frequent and severe complication in patients with cirrhosis. Identifying patients at high risk for AKI progression and in-hospital complications could enable timely targeted interventions. Given the central role of inflammation in AKI and cirrhosis, we investigated whether inflammatory biomarkers could provide prognostic insights. Methods: In this multicenter, prospective cohort study, we enrolled 188 patients with cirrhosis and AKI from four tertiary care centers. Urine and plasma samples were analyzed for four biomarkers: urine monocyte chemoattractant protein-1 (MCP-1), urine YKL-40, and plasma tumor necrosis factor receptors 1 and 2 (TNFR-1, TNFR-2). Biomarkers were assessed for their associations with AKI progression, mortality, and in-hospital complications using multivariate analyses adjusted for demographics, baseline kidney function, and MELD score. Results: Urine MCP-1, plasma TNFR-1, and plasma TNFR-2 were each associated with increased odds of AKI progression and mortality: urine MCP-1 had odds ratio (OR) 2.35 (95% CI,1.26–5.65), plasma TNFR-1 OR 6.90 (95% CI,2.45–25.50), and plasma TNFR-2 OR 2.69 (95% CI,1.34–6.17) per standard deviation (SD) higher biomarker level. Plasma TNFR-1 had the strongest associations with in-hospital complications. Each SD higher plasma TNFR-1 was associated with developing hepatic encephalopathy (OR 2.53; 95% CI,1.37–5.06), developing spontaneous bacterial peritonitis (OR 2.20; 95% CI,1.14–4.47), variceal bleeding during admission (OR 3.47; 95% CI,1.05-14.46), and requiring dialysis (OR 2.81; 95% CI,1.39–6.23). Discussion: Inflammatory biomarkers effectively identify high-risk patients with AKI and cirrhosis. Incorporating these biomarkers into clinical decision-making has the potential to guide treatment.
Puthumana et al. (2026) studied this question.