Prevalence and short-term outcome of hepatorenal syndrome: A 9-year experience in a high-complexity hospital in Colombia.
Prevalence and short-term outcome of hepatorenal syndrome: A 9-year experience in a high-complexity hospital in Colombia.
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DOI：
10.1371/journal.pone.0239834
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Sierra-Arango F
中科院分区：
文献类型：
--
作者：
Rey R M;Delgado AF;De Zubiria A;Pinto R;De la Hoz-Valle JA;Pérez-Riveros ED;Ardila G;Sierra-Arango F
肝肾综合征是一种罕见的疾病，是肝硬化更严重阶段并发症的一部分。如果不进行治疗，其死亡率会显着增加。特利加压素被认为是需要肝移植之前的首选治疗方法。目的是根据既定的管理类型确定其患病率，确定患者的特征、触发因素和 90 天生存率。这是在哥伦比亚进行的一项回顾性队列研究。其中包括符合肝肾综合征标准的肝硬化和急性肾损伤患者，2007年至2015年期间达到28例。根据肝肾综合征的类型和治疗进行分组。对人口统计和触发因素进行了评估，以表征人口特征。使用 log Rank 检验分析特利加压素与去甲肾上腺素的治疗结果直至 90 天的生存期。连续变量需要 Student 的 T 和 Mann Whitney 的 U 检验以及分类变量 Chi2 检验。考虑 p <0.05 的值和 85% 的功效。数据在 SPSS 23 版软件中进行分析。 117名肝硬化患者出现肾损伤；其中 23.9% 被诊断患有肝肾综合征（67.8% 为 1 型；32.1% 为 2 型）。 HRS2 中腹水的存在率为 100%，HRS1 中腹水的存在率为 84% (p = 0.296)。这两种类型的主要触发因素是过去 4 周内穿刺量超过 5 升 (39.3%)。总共有 35% 的患者接受了肾脏替代治疗，14% 的患者接受了肝移植。 1 型更为常见（63% 接受特利加压素；21% 接受去甲肾上腺素）。总完全缓解率为 36%（类型 2 为 66.6%，类型 1 为 18.7%）（p = 0.026）。相比之下，90 天随访时的总死亡率为 67.8%（1 型为 89.4%，2 型为 22%）（p = <0.001）。我们发现接受特利加压素治疗的患者死亡率低于接受去甲肾上腺素治疗的患者（p = 0.006）。哥伦比亚关于这种情况的临床和流行病学信息很少。由于我们研究样本量的限制，无法规定两种药物之间存在显着差异。 90 天随访时的总体死亡率很高，HRS1 患者的死亡率更高。虽然这项研究的结果提示了哥伦比亚人群中 HRS 患者的临床信息，但也应谨慎解释，因此应进行进一步的多中心研究。
Hepatorenal syndrome is a rare entity that is part of the complications of liver cirrhosis in its more severe stages. Without treatment, its mortality rate increases significantly. Terlipressin is considered to be the therapy of choice until the need of a liver transplant. The aim is to determine its prevalence, define patients’ characteristics, triggers and 90-day survival, according to the type of managements established. This was a retrospective cohort study conducted in Colombia. It included patients with cirrhosis and acute kidney injury who met hepatorenal syndrome criteria, reaching 28 patients from 2007 to 2015. Groups were categorized according the type of hepatorenal syndrome and treatment. Demographic and trigger factors were evaluated to characterize the population. Treatment outcomes with terlipressin vs norepinephrine were analyzed up to a 90-day survival, using log Rank test. Continuous variables needed Student's T and Mann Whitney's U tests and categorical variables, Chi2 test. A value of p <0.05 and a power of 85% was considered. The data was analyzed in the SPSS version 23 software. 117 patients with cirrhosis developed renal injury; of these 23.9% were diagnosed with Hepatorenal Syndrome (67.8% type1; 32.1% type2). The presence of ascites was 100% in HRS2 and 84% in HRS1 (p = 0.296). The main trigger in both types was paracentesis greater than 5 liters in the last 4 weeks (39.3%). In total, 35% of the patients received renal replacement therapy and 14% underwent a hepatic transplant. Type 1 was more frequent (63% received terlipressin; 21% norepinephrine). The total complete response was 36% (Type2 66.6% vs. Type1 18.7%) (p = 0.026). In contrast, the overall mortality was of 67.8% at 90-day of follow-up (89.4% Type1 vs. 22% Type2) (p = <0.001). We found a lower mortality rate in patients treated with terlipressin than treated with norepinephrine (p = 0.006). There is scarce clinical and epidemiological information about this condition in Colombia. A significant difference between the two drugs cannot be stipulated due to the limitation in the sample size of our study. The general mortality at a 90-day follow-up was high, being higher in patients with HRS1. While the results of this study are suggestive of clinical information for HRS patients in the Colombian population, they should also be interpreted with caution, therefore further multicenter studies should be performed.
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DOI：
10.1016/j.cgh.2017.05.041
发表时间：
2018-03
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Mindikoglu AL;Pappas SC
通讯作者：
Pappas SC
影响因子：
29.4
作者：
Boyer, Thomas D.;Sanyal, Arun J.;Pappas, Stephen Chris
通讯作者：
Pappas, Stephen Chris
影响因子：
13.5
作者：
Cárdenas, A;Ginès, P;Rodes, J
通讯作者：
Rodes, J
影响因子：
29.4
作者：
GINES, A;ESCORSELL, A;RODES, J
通讯作者：
RODES, J
影响因子：
2.5
作者：
Jiang, Weiyun;Hu, Yechao;Xun, Yunhao
通讯作者：
Xun, Yunhao