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.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the All India Institute of Medical Sciences, New Delhi ethics committee [Approval reference no. IEC.473/07.10.2016 and IEC.369/01.08.2016/RP-20/2016] and abides by the Declaration of Helsinki. Informed and written consent was obtained from each study participant and any identifiers were withheld from the study analyses.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data associated with this manuscript are available within the manuscript files.