Serum Uric Acid and Inflammatory Biomarkers as Predictors of Acute Kidney Injury in Hospitalized Patients with Decompensated Cirrhosis: A Prospective Observational Study

Abstract

Background: Acute kidney injury (AKI) is a frequent complication of decompensated cirrhosis and is associated with adverse clinical outcomes. Early identification of patients at increased risk may support closer monitoring and timely management. This study evaluated serum uric acid and inflammatory biomarkers as predictors of AKI in hospitalized patients with decompensated cirrhosis. Methods: This prospective observational cohort study included 100 consecutive patients aged 18-60 years hospitalized with decompensated cirrhosis in Guwahati, India, from January 2024 to January 2026. Serum uric acid, C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) were assessed at admission. Multivariable logistic regression and receiver-operating-characteristic analyses were used to evaluate associations with and discrimination for AKI. Results: AKI developed in 34 patients (34.0%). Serum uric acid was higher in the AKI group than in the non-AKI group (8.7 ± 1.6 vs 6.1 ± 1.4 mg/dL; P<0.001), and CRP and NLR were also significantly elevated. Serum uric acid, CRP, NLR, and MELD-Na remained independently associated with AKI. Serum uric acid yielded an AUC of 0.823, while the combined model incorporating uric acid, CRP, and NLR yielded an AUC of 0.891 (sensitivity 85.3%; specificity 81.8%). Conclusion: Serum uric acid, CRP, and NLR may provide readily available markers for early AKI risk stratification in hospitalized patients with decompensated cirrhosis. External validation is required before the proposed cut-offs are adopted in routine practice. Keywords: Acute kidney injury; decompensated cirrhosis; serum uric acid; C-reactive protein; neutrophil-to-lymphocyte ratio; biomarkers.