Overestimated Renal Function in Patients with Liver Cirrhosis Predicts Poor Prognosis
Overestimated Renal Function in Patients with Liver Cirrhosis Predicts Poor Prognosis
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高估肝硬化患者的肾功能预示预后不良
DOI：
10.1111/hepr.13765
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发表时间：
2022
影响因子：
4.2
通讯作者：
et al.,
中科院分区：
文献类型：
--
作者：
Yoshida Sonoe;Suda Goki;et al.,
目的肝硬化（LC）患者肾功能被高估的患病率很高，但其对预后的影响尚不清楚。我们的目的是评估高估的肾功能对LC.MethodsAn患者预后的影响被定义为一个高估的肾功能肌酐为基础的估计肾小球滤过率（eGFR）的增加>20%，与半胱氨酸蛋白酶抑制剂C为基础的eGFR。LC患者保守血清，肌肉萎缩，并有适当的临床信息进行了评估，其预后因素进行了analysed.ResultsA共215例连续LC患者被列入。高估肾功能的发生率为29.8%（64/215）。Kaplan-Meier生存分析显示，高估肾功能的患者的预后比未高估肾功能的患者差（风险比[HR]：2.217，95%置信区间[CI]：1.290-3.810;p= 0.001）。亚组分析表明，高估肾功能是一个重要的预后因素，无论性别和肝细胞癌（HCC）的存在。多因素考克斯回归分析显示，在整个队列中，高估肾功能是预测预后不良的重要独立因素（HR：2.050; 95% CI：1.041-4.037;p= 0.038）和按Child-Pugh A级分类的亚组（HR：2.131; 95% CI：1.019-4.458;p= 0.044），终末期肝病模型评分≤9（HR：2.303; 95% CI：1.038-5.109;p= 0.04），有无肝细胞癌（HR：2.290; 95% CI：1.128-4.651;p= 0.022）。
AimA high prevalence of overestimated renal function in patients with liver cirrhosis (LC) has been reported; nonetheless, its impact on prognosis remains unclear. We aimed to evaluate the impact of overestimated renal function on prognosis in patients with LC.MethodsAn overestimated renal function was defined as a >20% increase in the creatinine‐based estimated glomerular filtration rate (eGFR), compared with cystatin C‐based eGFR. LC patients with conserved serum, who were evaluated for muscle atrophy and had proper clinical information were included, and their prognostic factors were analyzed.ResultsA total of 215 consecutive patients with LC were included. The prevalence of overestimated renal function was 29.8% (64/215). Kaplan‐Meier survival analysis revealed that patients with overestimated renal function had a poorer prognosis than those without overestimated renal function (hazard ratio [HR]: 2.217 95% confidence interval [CI]: 1.290–3.810;p= 0.001). Subgroup analysis showed that overestimated renal function was a significant prognostic factor, irrespective of sex and the presence of hepatocellular carcinoma (HCC). Multivariate Cox regression analyses revealed that overestimated renal function was a significant and independent factor predictive of poor prognosis in the entire cohort (HR: 2.050; 95% CI: 1.041–4.037;p= 0.038) and in subgroups classified by Child‐Pugh class A (HR: 2.131; 95% CI: 1.019–4.458;p= 0.044), Model for End‐Stage Liver Disease score ≤9 (HR: 2.303; 95% CI: 1.038–5.109;p= 0.04), and presence of HCC (HR: 2.290; 95% CI: 1.128–4.651;p= 0.022).ConclusionOverestimated renal function is a significant and independent prognostic factor in patients with LC.