Acute kidney injury in decompensated cirrhosis
Acute kidney injury in decompensated cirrhosis
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DOI：
10.1136/gutjnl-2011-301255
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发表时间：
2013-01-01
期刊：
影响因子：
24.5
通讯作者：
Wong, Florence
中科院分区：
文献类型：
--
作者：
Tsien, Cynthia D.;Rabie, Rania;Wong, Florence
背景：肝硬变合并腹水的肝肾综合征是一种定义明确的疾病，具有显著的发病率和死亡率。目前尚不清楚轻度急性肾损伤(AKI)是否也会对患者的预后产生负面影响。AKI是指血清肌酐较基线水平升高超过26.4mU/L(0.3 mg/dl)或较基线水平升高50%以上的急性肾损伤。目的确定肝硬化腹水患者中AKI的患病率以及AKI对患者预后的影响。结果入选患者90例，平均年龄55.8±0.8岁，平均随访14.05±1.07个月。49名患者发生82次急性心肌梗死，大多数发作是由全身血流动力学障碍引起的。AKI发作的平均峰值血肌酐在实验室的正常范围内。AKI的73集已经解决；9集没有解决。对于AKI的发展或缓解，没有明确的临床预测指标。尽管大多数急性心肌梗死患者的病情得到缓解，但在随访过程中，患者的血肌酐逐渐显著升高，平均动脉压逐渐降低，与非急性心肌梗死患者相比，患者的存活率显著降低。应尽量避免AKI在肝硬变和腹水中沉淀。
Background Hepatorenal syndrome in cirrhosis with ascites is a well-defined entity with significant morbidity and mortality. It is unclear whether milder degrees of acute kidney injury (AKI), defined as a serum creatinine increase of over 26.4 mu mol/l (0.3 mg/dl) or by 50% from baseline, also has a negative impact on patient outcomes.Objectives To determine the prevalence of AKI in cirrhosis with ascites and the impact of AKI on patient outcomes.Design Patients with cirrhosis with ascites and baseline serum creatinine less than 110 mu mol/l, and no evidence of structural renal disease, prospectively underwent 4-6-weekly blood work-up for full blood count, biochemistry and liver function. Clinical assessments occurred every 4 months for the development of AKI and other complications.Results 90 patients (mean age 55.8 +/- 0.8 years) with a mean follow-up of 14.05 +/- 1.07 months were enrolled. 82 episodes of AKI occurred in 49 patients, with the majority of episodes precipitated by a disturbance in systemic haemodynamics. The mean peak serum creatinine of the AKI episodes was within the laboratory's normal range. 73 episodes of AKI resolved; nine did not. There was no clear clinical predictor for the development or resolution of AKI. Despite resolution of most AKI episodes, a gradual and significant increase in serum creatinine and a gradual reduction in mean arterial pressure were observed during follow-up, associated with a significant reduction in survival compared with non-AKI patients.Conclusion Minor increases in serum creatinine are clinically relevant and can adversely affect survival. Every effort should be made to avoid precipitation of AKI in cirrhosis and ascites.