The prevalence of AKI in this study was 25.2%, which is in agreement with the previously published literature [3, 20, 21]. A lower prevalence of 12.9% and 17.0% was reported by Choi et al. [1] and Terra et al. [22], respectively. Gessolo Lins et al. [23] reported a prevalence of 53.9% which was notably higher compared to the 25.2% prevalence observed in the present study.

The individuals involved in this study had a mean age of 51.46 years. The most common etiology was similar to that of national and international cohorts alcoholic cirrhosis [24], followed by NAFLD. A similar trend was observed in previous studies conducted by Thapa et al. [25] in Nepal where the mean age of their study groups was 51.8 years. In a study conducted by Gessolo Lins et al. [23], it was similarly noted that the primary cause of AKI in patients with liver cirrhosis is alcohol consumption.

When comparing the two groups, the analysis showed that individuals with AKI exhibited a notably higher prevalence of liver cirrhosis-related symptoms such as jaundice, edema, and icterus in comparison to the non-AKI group. Furthermore, laboratory investigation showed that total bilirubin, direct bilirubin, potassium, creatinine, urea, and INR was significantly higher among AKI patients than those without AKI (p < 0.05). Our data agreed with the study conducted by Metha et al. [26], Duah et al. [3], and Lasheen et al. [27], where laboratory parameters like bilirubin, potassium, creatinine, and INR were associated with AKI. In the present study, we observed significant decrease in serum albumin, globulin, and sodium (p < 0.05) which was in line with the study recently conducted by Duah et al. [3].

The regression analysis conducted to identify risk factors showed that there were differences in the renal risk profile between the cirrhosis and cirrhosis with AKI. Notably, higher levels of direct bilirubin and a higher MELD score emerged as significant risk factors associated with AKI development in liver cirrhosis patients. In a study by Tariq et al. [28], they reported that factors such as the MELD score, CTP stage C, the presence of ascites, and the presence of sepsis were predictors accompanying with AKI. Similarly, Gameiro et al. identified MELDNa as an independent predictive factor for AKI [29]. Another study also have also pointed to CTP, INR, total bilirubin, serum albumin, platelet count, total leukocyte count, presence of spontaneous bacterial peritonitis, and septic shock as the risk factors contributing to the AKI development [6]. A recently published systematic review and meta-analysis conducted by Nall et al. showed that high MELD score, infection, high CTP stage, high SCr, high serum bilirubin, and low serum albumin were significantly associated with a high incidence of AKI in liver cirrhosis patients [30]. All these studies corroborate our findings, emphasizing the parameters associated with a heightened risk of AKI in liver cirrhosis patients.

In our study, according to the updated 2015 ICA categorization, AKI stage 1 was the predominant stage observed, followed by stage 2 AKI. A similar trend was noted in the study by Thapa et al. [25], where the majority of the study population had stage 1 AKI (42%), followed by stage 3 AKI (30%). In a study by Huang et al. [31], among 217 patients with AKI, 132 (60.8%), 58 (26.7%), and 27 (12.4%) patients met ICA-AKI stages 1, 2, and 3, respectively. Regarding the etiological classification of AKI, the majority of cases in our study were prerenal AKI type. In study conducted by Moreau et al. [32], the most common causes of AKI in cirrhotic patients are PRA. Forty-nine percent of the patients had PRA, and 35% accounted for ATN.

AKI poses a heightened risk of mortality in many individuals with liver cirrhosis. Even patients with mild renal impairment (peak AKI stage 1) experienced significantly higher 90-day mortality rates compared to those without any renal impairment [2, 33]. In the present study, the over-all in-hospital mortality rate was 4.37%, while 30- and 90-day mortality rates were 14.01% and 23.35%, respectively, with high MELD score and presence of AKI being the independent risk factors for mortality in the study population. A study by Musunuri et al. [34] showed that INR and severity score (CTP) predict 90-day mortality in individuals with AKI in liver cirrhosis. A recent study conducted in Vietnam also found that hyponatremia, increased total bilirubin, and prothrombin < 70% substantially expanded the mortality percentage in patients with decompensated cirrhosis [35].

Among AKI classification, a 30-day (p = 0.014) and 90-day (p = 0.018) mortality rate was significantly higher in ATN group followed by HRS, respectively. Additionally, with respect to AKI severity, 30 days and 90 days mortality rate was significantly higher in AKI stage 3 followed by AKI stage 2, respectively. In a prospective study by Thapa et al., mortality rate was higher among patients with AKI stage-3 compared to AKI stage 1 and 2 [25]. Another study on 192 hospitalized liver cirrhosis patients reported that in-hospital mortality differed from 2% for AKI stage 1, 7% for AKI stage 2, and up to 21% for AKI stage 3. Additionally, the mortality rates for stage 1 patients who progressed to stages 2 and 3 were 29% and 60%, respectively [36]. Another study also revealed a substantial correlation between rising AKI severity and hospital mortality [37]. A study by Allegretti et al. reported that HRS and ATN result in similar 90-day mortality [38]. A recent study by Patidar et al. showed the lowest mortality rate in patients with PRA, while mortality were higher in ATN (52.7%) but not significantly different from HRS (49.0%) [39].

The Kaplan–Meier survival analysis showed that liver cirrhosis patients with AKI experienced the highest 90-day mortality rates, which aligned with the study conducted by Nguyen et al. [35]. Furthermore, there was an observation that the stage and type of AKI had an impact on patient survival rates. The present study indicated a statistically significant increase in mortality (p value 0.010) among patients in the ATN group and those at stage 3 on day 90.

Limitation of our study is its single-center design, which may restrict the generalizability of our findings. Additionally, the relatively small sample size utilized in this study could potentially limit the statistical power and precision of our results. In spite of these limitations, a significant contribution of this study is its emphasis on the association between AKI and heightened mortality rates among hospitalized individuals with cirrhosis. The findings of the correlation between survival rates and the type and stage of AKI contributes to the need for enhanced management strategies for the betterment of patient outcomes.