Jaundice Increases the Rate of Complications and One-Year Mortality in Patients With Hypoxic Hepatitis
Jaundice Increases the Rate of Complications and One-Year Mortality in Patients With Hypoxic Hepatitis
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DOI：
10.1002/hep.25896
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发表时间：
2012-12-01
期刊：
影响因子：
13.5
通讯作者：
Fuhrmann, Valentin
中科院分区：
文献类型：
--
作者：
Jaeger, Bernhard;Drolz, Andreas;Fuhrmann, Valentin
缺氧性肝炎(HH)是危重病患者急性肝损伤最常见的原因。目前尚无HH患者新发黄疸的临床数据。本研究旨在评价HH危重病患者黄疸的发生率及临床疗效。对连续206例高血压病患者在高血压病过程中是否发生黄疸进行了筛查。入院时有黄疸或肝硬变的患者(n=31)被排除在分析之外。血浆总胆红素水平<3 mg/dL的患者被诊断为黄疸。一年的生存、感染和心肺、胃肠道(GI)、肾脏和肝脏并发症被前瞻性地记录下来。175例HH患者中有63例(36%)出现新发黄疸。在HH急性事件中存活的患者中，黄疸持续时间的中位数为6天(四分位数范围为3-8天)。与无黄疸的患者(第2组)相比，发生黄疸的患者(第1组)需要更多的血管加压治疗(P<；0.05)、肾脏替代治疗(P<；0.05)和机械通气(P<；0.05)，并且去甲肾上腺素的最大用量(P<；0.05)更高。第一组的一年生存率显著低于第二组(分别为8%和25%；P<；0.05)。黄疸的发生与随访期间并发症发生率的增加有关(第1组为54%，第2组为35%；P<；0.05)。特别是，在随访期间，组1感染以及肾脏和胃肠道并发症的发生率更高。结论：黄疸是HH病程中常见的表现。这会增加HH患者的并发症发生率和更糟糕的结局。(《肝病》2012；56：2297-2304)
Hypoxic hepatitis (HH) is the most frequent cause of acute liver injury in critically ill patients. No clinical data exist about new onset of jaundice in patients with HH. This study aimed to evaluate the incidence and clinical effect of jaundice in critically ill patients with HH. Two hundred and six consecutive patients with HH were screened for the development of jaundice during the course of HH. Individuals with preexisting jaundice or liver cirrhosis at the time of admission (n = 31) were excluded from analysis. Jaundice was diagnosed in patients with plasma total bilirubin levels >3 mg/dL. One-year-survival, infections, and cardiopulmonary, gastrointestinal (GI), renal, and hepatic complications were prospectively documented. New onset of jaundice occurred in 63 of 175 patients with HH (36%). In patients who survived the acute event of HH, median duration of jaundice was 6 days (inter-quartile range, 3-8). Patients who developed jaundice (group 1) needed vasopressor treatment (P < 0.05), renal replacement therapy (P < 0.05), and mechanical ventilation (P < 0.05) more often and had a higher maximal administered dose of norepinephrine (P < 0.05), compared to patients without jaundice (group 2). One-year survival rate was significantly lower in group 1, compared to group 2 (8% versus 25%, respectively; P < 0.05). Occurrence of jaundice was associated with an increased frequency of complications during follow-up (54% in group 1 versus 35% in group 2; P < 0.05). In particular, infections as well as renal and GI complications occurred more frequently in group 1 during follow-up. Conclusion: Jaundice is a common finding during the course of HH. It leads to an increased rate of complications and worse outcome in patients with HH. (HEPATOLOGY 2012;56:2297-2304)