RISK-FACTORS AND OUTCOME OF 107 PATIENTS WITH DECOMPENSATED LIVER-DISEASE AND ACUTE-RENAL-FAILURE (INCLUDING 26 PATIENTS WITH HEPATORENAL-SYNDROME) - THE ROLE OF HEMODIALYSIS
RISK-FACTORS AND OUTCOME OF 107 PATIENTS WITH DECOMPENSATED LIVER-DISEASE AND ACUTE-RENAL-FAILURE (INCLUDING 26 PATIENTS WITH HEPATORENAL-SYNDROME) - THE ROLE OF HEMODIALYSIS
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DOI：
10.3109/08860229509026250
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发表时间：
1995-01-01
期刊：
影响因子：
3
通讯作者：
BUTTNER, P
中科院分区：
文献类型：
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作者：
KELLER, F;HEINZE, H;BUTTNER, P
已有肝失代偿的患者发生急性肾衰竭的预后很差，血液透析无效，尤其是肝肾综合征（HRS）。由于我们在一些患者中观察到更有利的结果，我们回顾性评估了10年期间（1980-1990）在某大学医院医疗部门治疗的107例失代偿性肝病和急性肾功能衰竭（血清肌酐> 200 μmol/L）患者。 107 名患者中，有 26 名 (24%) 被诊断为严格意义上的 HRS（服用速尿时尿钠 < 20 mmol/L）。 25名患者肾功能保持代偿，82名患者满足透析治疗标准（肌酐>500μmol/2和/或利尿<500mL/天）。与现行理论相反，82 名患者中有 38 名接受了血液透析（46%）。使用Cox比例风险模型，血小板减少症<100/nL的患者的死亡相对风险（存在与不存在危险因素）增加8.2倍（3.9-17.2），肝性脑病患者和凝血酶原时间<30%的患者增加3.9倍（1.4-11.3），血小板减少症患者的死亡相对风险增加2.8倍（1.6-4.8）。恶性肿瘤，尽管有适应症但未接受透析的患者为 2.7 倍（1.5-4.8）。在 CART 统计数据（分类和回归分析）中，结果最差的 33 名患者的特点是血小板减少症 < 100/nL。严格意义上的HRS也不是一个独立的危险因素。CART组的43名预后良好（代偿性肾衰竭或血液透析治疗，无恶性肿瘤）的患者的1年生存率为38%。我们得出的结论是，血小板减少症、脑病和恶性肿瘤（不包括 HRS 本身）是导致急性肾功能衰竭和失代偿性肝病患者的血液透析无效的致命体征。
The prognosis of acute renal failure in patients with preexisting liver decompensation is poor and hemodialysis is considered futile, especially for hepatorenal syndrome (HRS). Since we observed a more favorable outcome in some patients, we retrospectively evaluated 107 patients with decompensated liver disease and acute renal failure (serum creatinine > 200 mu mol/L) treated at the medical department of a university hospital in a 10-year period (1980-1990). HRS in the strict sense (urine-Na < 20 mmol/L while on furosemide) was diagnosed in 26 of 107 patients (24%). Renal function remained compensated in 25 patients, while 82 patients fulfilled the criteria for dialysis treatment (creatinine > 500 mu mol/2 and/or diuresis < 500 mL/day). In contrast to the current doctrine, 38 of the 82 patients were given hemodialysis (46%). Using the Cox proportional hazard model, the relative risk (presence vs, absence of a risk factor) of dying was increased 8.2-foId (3.9-17.2) in patients with thrombocytopenia < 100/nL, 3.9-fold (1.4-11.3) in those with hepatic encephalopathy and prothrombin time < 30%, 2.8-fold (1.6-4.8) in patients with malignoma, and 2.7-fold (1.5-4.8) in patients not submitted to dialysis despite its indication. In the CART statistics (classification and regression tress), the 33 patients with the poorest outcome were characterized exclusively by thrombocytopenia < 100/nL. HRS in the strict sense was nor an independent risk factor The CART group of 43 patients with favorable prognosis (compensated renal failure or treatment by hemodialysis, absent malignancy) had a 1-year survival rate of 38%. We conclude that thrombocytopenia, encephalopathy and malignoma, bur not HRS per se, are fatal signs that make hemodialysis futile in patients with acute renal failure and decompensated liver disease.