Renal failure after upper gastrointestinal bleeding in cirrhosis:: Incidence, clinical course, predictive factors, and short-term prognosis
Renal failure after upper gastrointestinal bleeding in cirrhosis:: Incidence, clinical course, predictive factors, and short-term prognosis
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DOI：
10.1053/jhep.2001.27830
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发表时间：
2001-10-01
期刊：
影响因子：
13.5
通讯作者：
Rodes, J
中科院分区：
文献类型：
--
作者：
Cárdenas, A;Ginès, P;Rodes, J
为探讨肝硬变合并消化道出血患者肾功能衰竭的发生率、临床病程、预测因素及预后，对161例患者175例连续发生的消化道出血进行分析。发生肾功能衰竭20例(11%)，其中8例为一过性肾功能衰竭，12例为非一过性肾功能衰竭。与年龄和出血严重程度相匹配的对照组相比，肝硬变患者的肾功能衰竭更为常见。在入院时或住院期间获得的与出血事件或肝肾功能相关的39个临床和实验室变量中，低血容量性休克的存在、输入的压缩红细胞数量、入院时的Child-Pugh分级和基线血小板计数是肾功能衰竭的独立预测因素。发生肾功能衰竭和低血容量性休克是住院死亡率的唯一独立预测因素。在发生肾功能衰竭的20例患者中，死亡率为55%(11例死亡)，而在155例无肾功能衰竭的患者中，死亡率仅为3%(5例死亡)(P<；0.01)。与短暂性肾功能衰竭相比，非短暂性肾功能衰竭的死亡率要高得多(10/12[83%]比1/8[12%]；P<；.01)。综上所述，肾功能衰竭是肝硬变并消化道出血患者的常见事件，其发生主要与出血的严重程度和基础肝功能有关。肾功能衰竭是肝硬变和胃肠道出血患者死亡率的强烈预测因素。
To assess the incidence, clinical course, predictive factors, and prognosis of renal failure in patients with cirrhosis and gastrointestinal bleeding, 175 consecutive episodes of gastrointestinal bleeding in 161 patients were analyzed. Renal failure occurred in 20 (11%) episodes and was transient in 8 episodes and nontransient in 12. Renal failure was more common in patients with cirrhosis than in a control population of bleeding patients without cirrhosis matched by age and severity of the bleeding episode. Among 39 clinical and laboratory variables obtained at admission or during hospitalization related with the bleeding episode or with liver and renal function, the presence of hypovolemic shock, number of packed red blood cells transfused, Child-Pugh class at admission, and baseline platelet count were independent predictors of renal failure. The development of renal failure and hypovolemic shock was the only independent predictors of in-hospital mortality. Mortality rate among the 20 episodes with renal failure was 55% (11 deaths) as compared with only 3% (5 deaths) in the 155 episodes without renal failure (P < .01). The development of nontransient renal failure entailed a much greater mortality as compared with transient renal failure (10 of 12 [83%] vs. 1 of 8 [12%]; P < .01). In conclusion, renal failure is a common event in patients with cirrhosis and gastrointestinal bleeding, the occurrence of which is mainly related to the severity of bleeding and baseline liver function. Renal failure is a strong predictor of mortality in patients with cirrhosis and gastrointestinal bleeding.