Acute Kidney Injury Is an Early Predictor of Mortality for Patients With Alcoholic Hepatitis
Acute Kidney Injury Is an Early Predictor of Mortality for Patients With Alcoholic Hepatitis
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DOI：
10.1016/j.cgh.2011.09.011
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发表时间：
2012-01-01
影响因子：
12.6
通讯作者：
Bataller, Ramon
中科院分区：
文献类型：
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作者：
Altamirano, Jose;Fagundes, Claudia;Bataller, Ramon
背景与目的：酒精性肝炎（AH）是一种严重的疾病，死亡率高。为了改善治疗策略，重要的是要确定影响生存时间的因素。年龄、胆红素、国际标准化比值和肌酐评分系统（也称为ABIC评分系统）是以前开发的，用于确定AH患者的预后。我们研究了急性肾损伤（阿基）对AH患者生存率的影响。方法：我们回顾性分析了103例经活检证实的AH患者的资料。阿基定义为肾功能突然下降（48小时内），导致血清肌酐水平相对于基线绝对升高至少0.3 mg/dL（或升高50%）（阿基网络[AKIN]标准）。结果：29例患者（28%）在住院期间发生阿基，中位诊断时间为3天。总体90天死亡率为23%，AKI患者的死亡率显著高于无AKI患者（65% vs 7%; P < .0001）。年龄、胆红素、国际标准化比值、肌酐评分（P <0.0001）和阿基的发生（P <0.0001）是90天死亡率最准确的独立预测因子。全身炎症反应综合征（P < .0001）、血清胆红素（P =.入院时的国际标准化比值（P = 0.03）是阿基最准确的预测因子。重要的是，AKIN标准在预测90天死亡率方面比传统的肾功能衰竭标准（血清肌酐> 1.5 mg/dL）更准确（受试者操作特征下的面积分别为0.83 vs 0.70; P = 0.02）。结论：阿基的发展在短期内降低了AH患者的生存率。AKIN标准在预测死亡率方面比传统标准更有用和更准确。因此，在AH患者的管理中应考虑预防阿基的策略。
BACKGROUND & AIMS: Alcoholic hepatitis (AH) is a severe condition with high mortality. To improve therapeutic strategies, it is important to identify factors that affect survival times. The age, bilirubin, international normalized ratio, and creatinine scoring system (also known as the ABIC scoring system) was developed previously to determine the prognosis of patients with AH. We studied effects of acute kidney injury (AKI) on survival of patients with AH. METHODS: We retrospectively analyzed data from 103 patients with biopsy-proven AH. AKI was defined as an abrupt reduction (within 48 h) in kidney function that resulted in an absolute increase of at least 0.3 mg/dL (or a 50% increase) in serum levels of creatinine from baseline (the AKI network [AKIN] criteria). RESULTS: Twenty-nine patients (28%) developed AKI during hospitalization, with a median time to diagnosis of 3 days. Overall 90-day mortality was 23%, which was significantly higher among patients with AKI than those without (65% vs 7%; P < .0001). The age, bilirubin, international normalized ratio, and creatinine score (P < .0001) and development of AKI (P < .0001) were the most accurate independent predictors of 90-day mortality. The presence of systemic inflammatory response syndrome (P < .0001), serum bilirubin (P =. 01), and international normalized ratio at admission (P = .03) were the most accurate predictors of AKI. Importantly, the AKIN criteria were more accurate than traditional criteria for renal failure (serum creatinine > 1.5 mg/dL) in predicting 90-day mortality (area under the receiver operating characteristic, 0.83 vs 0.70, respectively; P = .02). CONCLUSIONS: Development of AKI reduces survival of patients with AH, in the short term. The AKIN criteria are useful and more accurate than traditional criteria in predicting mortality. Strategies to prevent AKI therefore should be considered in the management of patients with AH.