Impact of acute renal failure on mortality in end-stage liver disease with or without transplantation
Impact of acute renal failure on mortality in end-stage liver disease with or without transplantation
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DOI：
10.1046/j.1523-1755.1998.00004.x
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发表时间：
1998-08-01
影响因子：
19.6
通讯作者：
Johnson, JP
中科院分区：
文献类型：
--
作者：
Fraley, DS;Burr, R;Johnson, JP
背景。急性肾衰竭（ARF）传统上被认为是终末期肝病的预后不良因素，其死亡率接近90%。虽然原位肝移植（OLTX）使用的增加改变了终末期肝病（ESLD）患者的预后，但尚不清楚这是否影响了ESLD和arf患者的预后。我们前瞻性地跟踪了177例接受OLTX评估的ESLD患者的ARF病程。其中2例接受了OLTX治疗。将住院死亡率与316例无ARF的ESLD患者进行比较，其中196例接受了OLTX治疗。变量包括APACHE II评估的疾病严重程度、合并症、少尿、肾脏替代治疗的需要以及ESLD和ARF的病因。通过对arf患者进行多元回归分析，评估这些变量与住院死亡率的关系。少尿患者的死亡率明显高于非少尿患者和需要肾脏替代治疗的患者。死亡率与合并症的数量密切相关，尤其是败血症、脑病、呼吸衰竭和DIG。对于发生ARF的OLTX受者，无论ARF发生在OLTX前还是OLTX后，生存率均无显著差异。ARF与死亡率增加有关，这与已知的ARF对ESLD的不良预后影响一致。然而，在接受功能性OLTX的患者中，ARF对死亡率的影响显著降低。由于APACHE II评分在ARF组中产生的预期死亡率更高，因此尚不清楚在APACHE II捕获的生理紊乱之外，ARF是否有额外的影响。ARF本身不一定是肝移植的禁忌症。
Background. Acute renal failure (ARF) is traditionally considered a poor prognostic factor in end-stage liver disease and is associated with a mortality approaching 90%. While the increased use of orthotopic liver transplantation (OLTX) has changed the outcome for patients with end-stage liver disease (ESLD), it is not clear whether this has affected the outcome of patients with ESLD and ARF.Methods. We prospectively followed the course of ARF in 177 patients with ESLD being evaluated for OLTX. Of these patients ii received OLTX. In-hospital mortality was compared to that of 316 ESLD patients without ARF, of these 196 received OLTX. Variables include severity of illness as assessed by APACHE II, co-morbid conditions, oliguria, need for renal replacement therapy, and etiologies of ESLD and ARF. These variables were evaluated with respect to the outcome in-hospital mortality by multiple regression analysis for patients with ARF.Results. Mortality was significantly higher in oliguric versus non-oliguric patients and in patients who required renal replacement therapy. Mortality correlated strongly with the number of co-morbid conditions, especially sepsis, encephalopathy, respiratory failure, and DIG. For OLTX recipients who developed ARF, no significant difference in survival occurred whether the ARF was pre-OLTX or post-OLTX.Conclusion. ARF was associated with an increased mortality consistent with the known adverse prognostic effect of ARF in ESLD. However, the effect of ARF on mortality was remarkably reduced in patients who received a functioning OLTX. Since expected mortality generated from APACHE II scores was higher in the ARF groups, it is not clear that then is an additional effect of ARF beyond the physiologic derangements captured by APACHE II. ARF per se should not necessarily be a contraindication to liver transplant.