Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT
Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT
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DOI：
10.2215/cjn.03610417
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发表时间：
2018-01-06
影响因子：
9.8
通讯作者：
Thadhani, Ravi I.
中科院分区：
文献类型：
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作者：
Allegretti, Andrew S.;Parada, Xavier Vela;Thadhani, Ravi I.
背景和目的：关于因AKI而需接受RRT治疗的肝硬变患者预后的文献很少，而且受到肝移植资格的影响。需要更新未列入清单的分组的结果。我们的目标是比较这一组中被诊断为肝肾综合征和急性肾小管坏死的患者的预后，根据肝移植的列出状态进行分层。设计、设置、参与者和测量在五家医院(包括一家肝移植中心)对急性启动血液透析或持续RRT的肝硬变患者进行回顾性队列研究。结果共分析472例受试者(341例未列入，131例列入肝移植)。在未列出的受试者中，15%(341人中的51人)在开始RRT后6个月仍活着。诊断为肝肾综合征的患者中位生存期为21天(IQR，8，70)天，诊断为急性肾小管坏死者的中位生存期为12天(IQR，3，43天)(P=0.25)。在列出的受试者中，48%(131人中的63人)接受了肝移植。诊断为肝肾综合征的中位无移植生存期为15(IQR，5，37)天，诊断为急性肾小管坏死者为14(IQR，4，31)天(P=0.60)。当按移植名单分层时，使用调整后的COX模型，我们没有发现肝肾综合征和急性肾小管坏死之间的死亡风险差异(风险比[HR]，0.81；95%可信区间[95%CI]，在未列出的患者中，0.59至1.11；95%可信区间[95%CI]，0.73；95%CI，0.44至1.19，未列出的患者中)。在未列入肝移植名单的患者中，肝肾综合征和急性肾小管坏死患者的死亡率极高。
Background and objectives Literature on the prognosis of patients with cirrhosis who require RRT for AKI is sparse and is confounded by liver transplant eligibility. An update on outcomes in the nonlisted subgroup is needed. Our objective was to compare outcomes in this group between those diagnosed with hepatorenal syndrome and acute tubular necrosis, stratifying by liver transplant listing status.Design, setting, participants, & measurements Retrospective cohort study of patients with cirrhosis acutely initiated on hemodialysis or continuous RRT at five hospitals, including one liver transplant center. Multivariable regression and survival analysis were performed.Results Four hundred seventy-two subjects were analyzed (341 not listed and 131 listed for liver transplant). Among nonlisted subjects, 15% (51 of 341) were alive at 6 months after initiating RRT. Median survival was 21 (interquartile range [IQR], 8, 70) days for those diagnosed with hepatorenal syndrome and 12 (IQR, 3, 43) days for those diagnosed with acute tubular necrosis (P=0.25). Among listed subjects, 48% (63 of 131) received a liver transplant. Median transplant-free survival was 15 (IQR, 5, 37) days for those diagnosed with hepatorenal syndrome and 14 (IQR, 4, 31) days for those diagnosed with acute tubular necrosis (P=0.60). When stratified by transplant listing, with adjusted Cox models we did not detect a difference in the risk of death between hepatorenal syndrome and acute tubular necrosis (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.59 to 1.11, among those not listed; HR, 0.73; 95% CI, 0.44 to 1.19, among those listed).Conclusions Cause of AKI was not significantly associated with mortality in patients with cirrhosis who required RRT. Among those not listed for liver transplant, mortality rates were extremely high in patients both with hepatorenal syndrome and acute tubular necrosis.