Association of AKI with mortality and complications in hospitalized patients with cirrhosis.
Association of AKI with mortality and complications in hospitalized patients with cirrhosis.
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DOI：
10.1002/hep.25735
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发表时间：
2013-02
期刊：
影响因子：
13.5
通讯作者：
Parikh, Chirag R.
中科院分区：
文献类型：
--
作者：
Belcher, Justin M.;Garcia-Tsao, Guadalupe;Sanyal, Arun J.;Bhogal, Harjit;Lim, Joseph K.;Ansari, Naheed;Coca, Steven G.;Parikh, Chirag R.
急性肾损伤(AKI)是肝硬变患者常见且严重的并发症。然而，在涉及肝硬变患者的研究中使用的AKI的定义还没有标准化，缺乏敏感性，而且往往局限于狭窄的临床环境。我们对来自多个医院病房的肝硬变和急性肾损伤患者进行了一项多中心的前瞻性观察队列研究，利用现代急性肾损伤网络(AKIN)的定义，评估急性肾损伤的严重程度和进展与住院死亡率之间的关系。在纳入研究的192名患者中，85名(44%)患者在最初达到AKI标准后进展到更高的类似阶段。患者达到的最严重程度类似于阶段1，26%，阶段2，24%，阶段3，49%。死亡率、一般医疗事件(菌血症、肺炎、尿路感染)和肝硬变特殊并发症(腹水、脑病、自发性细菌性腹膜炎)的发生率随AKI的严重程度而增加。死亡患者的病情进展更为常见，急性心肌梗死的高峰期明显高于存活患者(p<；0.0001)。在调整了基线肾功能、人口统计学、危重医院和肝硬变相关变量后，AKI的进展与死亡率独立相关(调整后OR=3.8，95%可信区间1.3-11.1)。根据AKIN标准的定义，AKI在肝硬变患者中通常是进展性的和严重的，并以一种与分期相关的方式独立地与死亡率相关。早期诊断AKI及其进展的方法可能通过促进AKI的有针对性和及时的治疗而改善结果。
Acute kidney injury (AKI) is a common and devastating complication in patients with cirrhosis. However, the definitions of AKI employed in studies involving patients with cirrhosis have not been standardized, lack sensitivity and are often limited to narrow clinical settings. We conducted a multi-center, prospective observational cohort study of patients with cirrhosis and AKI, drawn from multiple hospital wards, utilizing the modern acute kidney injury network (AKIN) definition and assessed for the association between AKI severity and progression with inhospital mortality. Of the 192 patients that were enrolled and included in the study, 85 (44%) patients progressed to a higher AKIN stage after initially fulfilling AKI criteria. Patients achieved a peak severity of AKIN stage 1, 26%, stage 2, 24%, and stage 3, 49%. The incidence of mortality, general medical events (bacteremia, pneumonia, urinary tract infection) and cirrhosis specific complications (ascites, encephalopathy, spontaneous bacterial peritonitis) increased with severity of AKI. Progression was significantly more common and peak AKI stage higher in non-survivors than survivors (p < 0.0001). After adjusting for baseline renal function, demographics and critical hospital and cirrhosis associated variables, progression of AKI was independently associated with mortality (adjusted OR = 3.8, 95% CI 1.3–11.1). AKI, as defined by AKIN criteria, in patients with cirrhosis is frequently progressive and severe and is independently associated with mortality in a stage-dependent fashion. Methods for earlier diagnosis of AKI and its progression may result in improved outcomes by facilitating targeted and timely treatment of AKI.
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影响因子：
13.5
作者：
Cárdenas, A;Ginès, P;Rodes, J
通讯作者：
Rodes, J
影响因子：
38.9
作者：
du Cheyron, D;Bouchet, B;Charbonneau, P
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影响因子：
29.4
作者：
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Jalan, Rajiv
影响因子：
3.1
作者：
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通讯作者：
Rizzetto, M
影响因子：
38.9
作者：
Jenq, Chang-Chyi;Tsai, Ming-Hung;Yang, Chih-Wei
通讯作者：
Yang, Chih-Wei