Correlation Between MELD and UNa/K Ratio in Predicting Renal Dysfunction in Cirrhotic Patients
Correlation Between MELD and UNa/K Ratio in Predicting Renal Dysfunction in Cirrhotic Patients
复制标题
MELD 与 UNa/K 比值预测肝硬化患者肾功能障碍的相关性
DOI：
10.2478/jtim-2018-0033
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发表时间：
2018
影响因子：
4.9
通讯作者：
N. Luck
中科院分区：
文献类型：
--
作者：
J. Iqbal;M. A. Khalid;F. Hanif;R. Mandhwani;S. Laeeq;Z. Majid;N. Luck
背景：肾功能不全是肝硬化最可怕的并发症之一。MELD是一种经过验证的慢性肝病（CLD）严重程度评分系统。就低GFR而言，肝硬化患者尿(U) Na/K比值与肾功能密切相关。患者和方法纳入2015年6月至2017年6月在卡拉奇Sindh泌尿外科和移植研究所门诊部就诊的年龄在18至70岁之间的所有连续失代偿性肝硬化患者，不论性别。计算MELD评分，取UNa/K小于1作为肾功能不全的替代指标。采用SPSS（20.0版）进行统计学分析。结果共纳入71例患者。平均年龄43.79岁，以男性居多（67.6%）。最常见的肝硬化原因是HCV， 42例（59.2%）患者中有HCV。平均CTP评分为10.48±2.069（范围：6-14），大部分患者为C级，即48分（67.6%）。平均MELD评分为21.75±8.96（范围：8-43）。57例（80.3%）患者MELD评分为bb15。平均血清肌酐和平均血清钠分别为1.5±1.1 mg/dl（范围：0.37 ~ 5.3）和133.79±6.9 mmol/L（范围：112 ~ 152）。尿钠、尿钾均值分别为38.60±46.64 mmol/L（范围：5 ~ 181）和38.15±23.9 mmol/L（范围：4.3 ~ 112）。在大多数研究人群中，UNa/K比值小于1，即52例（73.2%）。MELD评分与UNa/K比值有统计学意义（χ = 0.34, P = 0.004）。结论MELD评分与UNa/K比值呈负相关，提示CLD患者MELD评分较高可能存在肾功能不全。然而，这一发现应该得到大规模研究的证实。
Abstract Background Renal dysfunction is one of the dreaded complications of cirrhosis. MELD is a validated chronic liver disease (CLD) severity scoring system. Urinary (U) Na/K ratio closely correlates with renal dysfunction in terms of low GFR in cirrhotic patients. Patients and Methods All consecutive patients with decompensated cirrhosis between the age of 18 to 70 years, of either gender, presenting in the outpatients’ department of Sindh Institute of Urology and Transplantation, Karachi, from June 2015 to June 2017 were included. The MELD score was calculated and the UNa/K ratio less than 1 was taken as surrogate marker of renal dysfunction. Statistical analysis was performed by SPSS (version 20.0). Results A total of 71 patients were enrolled. The mean age was 43.79 years and majority were male (67.6%). The most common cause of liver cirrhosis was HCV, found in 42 (59.2%) patients. The mean CTP score was 10.48 ± 2.069 (range: 6–14) with majority of the patients following in class C, that is, 48 (67.6%). Mean MELD score was 21.75 ± 8.96 (range: 8–43). In 57 patients (80.3%), MELD score was > 15.The mean serum creatinine and mean serum sodium were 1.5 ± 1.1 mg/dl (range: 0.37–5.3) and 133.79 ± 6.9 mmol/L (range: 112–152), respectively. Mean urinary sodium and urinary potassium were 38.60 ± 46.64 mmol/L (range: 5–181) and 38.15 ± 23.9 mmol/L (range: 4.3–112), respectively. In majority of study population, UNa/K ratio was below 1, that is, in 52 patients (73.2%). Statistically significant correlation was documented between MELD score and UNa/K ratio (ɤ = 0.34, P = 0.004). Conclusion The inverse correlation between MELD scores and UNa/K ratio indicates that patients with CLD and higher MELD scores might have renal dysfunction. This finding however should be corroborated by large scale studies.