The Influence of Gender on Diagnostic Markers of Acute Kidney Injury in Acute-on-Chronic Liver Failure

Gender has a profound impact on disease severity, outcomes and diagnosis yet, its role in clinical disease is insufficiently explored. Acute on chronic liver failure (ACLF) is associated with high mortality and multiple organ dysfunction, where acute kidney injury (AKI) significantly worsens prognosis. Here we investigated the impact of gender on the diagnostic parameters used for severity grading in ACLF. We enrolled 1134 ACLF patients, and shortlisted 757 patients (636 males, 121 females) admitted to AIIMS, New Delhi, between 2016 and 2023. ACLF-AKI was defined and staged according to International Club of Ascites (ICA) criteria. The impact of gender on baseline clinical parameters, AKI incidence, and progression were assessed using the statistical tools IBM SPSS 26.0 and GraphPad Prism Males exhibited a higher incidence of AKI (48.34%) compared to females (28.09%). However, no significant gender-based differences were observed in AKI stages. Males also had an overall high absolute value of sCr and blood urea compared to females. However, female ACLF patients who developed AKI exhibited a significantly higher δ sCr levels compared to males (p=0.003). In conclusion, gender-based differences were observed in the widely used diagnostic criteria of sCr and δ sCr for AKI in patients with ACLF. Although these findings are preliminary our results reveal gender-specific differences in sCr-based AKI diagnosis and risk stratification in ACLF. These results inform the need for deeper exploration of gender influenced parameters in ACLF specifically in AKI diagnosis.