Analysis of factors associated with the prognosis of cirrhotic patients who were treated with tolvaptan for hepatic edema
Analysis of factors associated with the prognosis of cirrhotic patients who were treated with tolvaptan for hepatic edema
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DOI：
10.1111/jgh.14965
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发表时间：
2020-01-14
影响因子：
4.1
通讯作者：
Iwakiri, Katsuhiko
中科院分区：
文献类型：
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作者：
Atsukawa, Masanori;Tsubota, Akihito;Iwakiri, Katsuhiko
背景与目的肝硬变合并肝性水肿者预后较差。尽管已经报道了几种托伐普坦(新型利尿剂)治疗此类患者的短期预测因素，但与长期生存相关的因素仍不清楚。方法在459例肝性水肿症患者中，我们分析了407例接受托伐普坦治疗的患者。结果男266例，女141例，年龄28~93岁，中位年龄68岁。托伐普坦短期有效率为59.7%(243/407)。在Cox回归分析中，对托伐普坦的短期疗效、托伐他坦治疗期间低平均剂量的速尿和螺内酯、Child-Pugh分级A和B级以及无肝细胞癌是影响1年生存率的独立因素。短期有效组的1年和长期累积生存率显著高于无应答组(P分别为0.011和0.010)。应用受试者工作特征曲线分析，呋塞米和螺内酯平均日剂量预测1年生存率的最佳临界值分别为19 mg/d和23 mg/d。在托伐普坦治疗期间，平均剂量为23 mg/d的螺内酯患者的长期累积存活率显著高于平均剂量为23 mg/d的患者(P=0.001)。结论托伐普坦的短期疗效和小剂量利尿剂可提高肝硬变患者的1年和远期存活率。
Background and Aim The prognosis of cirrhotic patients with hepatic edema is poor. Although several short-term predictors of tolvaptan (novel diuretic agent) treatment for such patients have been reported, the factors related to long-term survival are still unclear. Methods Among 459 patients with hepatic edema enrolled in a retrospective, multicenter collaborative study, we analyzed 407 patients who received tolvaptan. Results Patients consisted of 266 men and 141 women, with the median age of 68 years (range, 28-93 years). The frequency of short-term responders to tolvaptan was 59.7% (243/407). In the Cox regression analysis, short-term response to tolvaptan, low average dosages of furosemide and spironolactone during tolvaptan treatment, Child-Pugh classification A and B, and absence of hepatocellular carcinoma were independent factors contributed to 1-year survival. The 1-year and long-term cumulative survival rates in short-term responders were significantly higher than those in non-responders (P = 0.011 and 0.010, respectively). Using a receiver operating characteristic curve analysis, the optimal cut-off values of average daily dosages of furosemide and spironolactone for predicting 1-year survival were 19 and 23 mg/day, respectively. The long-term cumulative survival rates in patients who received a mean dosage of spironolactone < 23 mg/day during tolvaptan treatment were significantly higher than those receiving a mean dosage of >= 23 mg/day (P = 0.001). Conclusions The present study suggests that the short-term response to tolvaptan and low dosages of conventional diuretics during tolvaptan treatment might improve the 1-year and long-term survival rates in cirrhotic patients with hepatic edema.