Diagnosis, treatment and survival of patients with hepatorenal syndrome: A survey on daily medical practice
Diagnosis, treatment and survival of patients with hepatorenal syndrome: A survey on daily medical practice
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DOI：
10.1016/j.jhep.2011.03.012
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发表时间：
2011-12-01
影响因子：
25.7
通讯作者：
Angeli, Paolo
中科院分区：
文献类型：
--
作者：
Salerno, Francesco;Cazzaniga, Massimo;Angeli, Paolo
背景与目的：肝肾综合征（HRS）是肝硬化腹水的严重并发症。国际腹水俱乐部建议严格的诊断标准和血管收缩剂和白蛋白治疗。本前瞻性队列研究的目的是调查HRS的患病率，诊断标准，治疗和3个月的结果在日常临床practice.Methods：二百五十三个连续入院的肝硬化和肾功能衰竭患者21意大利hospitals.Results：HRS的患病率为45.8%（30%的1型和15.8%的2型）。在36%的病例中，由于并非所有诊断标准都能满足，因此推测为HRS。在8%的病例中，HRS叠加在器质性肾病上。HRS-1型患者更年轻，白细胞计数更高，呼吸频率更高，肝功能评分更差。64例HRS 1型患者接受血管收缩剂（40例特利加压素和24例米多君/奥曲肽）。完全缓解19例（30%），部分缓解13例（20%）。年龄是反应的唯一独立预测因素（p = 0.033）。HRS-1型患者的3个月生存率为19.7%。对治疗有反应的患者生存率更高。年龄（p = 0.017）、胆红素（p = 0.012）和诊断性容量扩张后肌酐升高（p = 0.02）独立预测死亡。至少有两个阴性predictors.Conclusions患者的死亡率为97%：HRS在我们的日常临床实践中的诊断标准不能完全满足三分之一的情况下。广泛应用血管收缩剂和白蛋白治疗。简单的基线变量对死亡率有很强的预测力。(C)2011年欧洲肝脏研究协会。由Elsevier B出版。V.保留所有权利。
Background & Aims: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with ascites. The International Ascites Club recommended strict diagnostic criteria and treatment with vasoconstrictors and albumin. Aim of this prospective cohort study was to investigate the prevalence of HRS, diagnostic criteria, treatment and 3-month outcome in the daily-clinical-practice.Methods: Two-hundred-fifty-three patients with cirrhosis and renal failure consecutively admitted to 21 Italian hospitals were recruited.Results: The prevalence of HRS was 45.8% (30% type-1 and 15.8% type-2). In 36% of cases HRS was presumed because not all diagnostic criteria could be fulfilled. In 8% of cases HRS was superimposed on an organic nephropathy. Patients with HRS type-1 were younger and showed higher leukocyte count, higher respiratory rates, and worse liver function scores. Sixty-four patients with HRS type-1 received vasoconstrictors (40 terlipressin and 24 midodrine/octreotide). A complete response was obtained in 19 cases (30%) and a partial response in 13 (20%). Age was the only independent predictor of response (p = 0.033). Three-month survival of patients with HRS type-1 was 19.7%. Survival was better in patients who responded to therapy. Age (p = 0.017), bilirubin (p = 0.012), and creatinine increase after diagnostic volume expansion (p = 0.02) independently predicted death. The mortality rate was 97% among patients with at least two negative predictors.Conclusions: The diagnostic criteria of HRS in our daily-clinical-practice could not be completely fulfilled in one third of cases. The treatment with vasoconstrictors and albumin was widely implemented. Mortality was strongly predicted by simple baseline variables. (C) 2011 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.