INCIDENCE, PREDICTIVE FACTORS, AND PROGNOSIS OF THE HEPATORENAL-SYNDROME IN CIRRHOSIS WITH ASCITES
INCIDENCE, PREDICTIVE FACTORS, AND PROGNOSIS OF THE HEPATORENAL-SYNDROME IN CIRRHOSIS WITH ASCITES
复制标题
DOI：
10.1016/0016-5085(93)90031-7
复制
发表时间：
1993-07-01
期刊：
影响因子：
29.4
通讯作者：
RODES, J
中科院分区：
文献类型：
--
作者：
GINES, A;ESCORSELL, A;RODES, J
背景：本研究的目的是探讨肝硬化腹水肝肾综合征的发病率，预测因素和预后方法：本研究是一个随访调查234例非氮血症肝硬化腹水患者。39个变量纳入分析作为肝肾综合征发生的可能预测因子（Kaplan-Meier法，Mantel-考克斯检验，逐步考克斯回归程序）。结果：肝肾综合征发生的概率为18%，在1年和39%，在5年。在单变量分析中，16个变量对肝肾综合征的发生具有预测价值：腹水、肝肿大、营养状况、血尿素氮水平、血清肌酐浓度、血清钠和钾浓度、血清和尿渗透压、尿钠排泄、水负荷后游离水清除率、肾小球滤过率、动脉压、血浆肾素活性、血浆去甲肾上腺素浓度和食道静脉曲张病因（酒精性与非酒精性）和Child-Pugh评分均无预测价值。多变量分析揭示只有三个独立的预测肝肾综合征的发生：低血清钠浓度，高血浆肾素活性，没有hepatomegaly.Conclusions：肝肾综合征是一个相对频繁的并发症，腹水，是与生存期极短的患者。肝脏大小、血浆肾素活性和血清钠浓度是这些患者肝肾综合征发生的预测因子。
Background:The aim of the study was to investigate the incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites.Methods: The study is a follow-up investigation in 234 nonazotemic patients with cirrhosis and ascites. Thirty-nine variables obtained at inclusion were analyzed as possible predictors of hepatorenal syndrome occurrence (Kaplan-Meier method, Mantel-Cox test, and step-wise Cox regression procedure).Results:The probability of hepatorenal syndrome occurrence was 18% at 1 year and 39% at 5 years. Sixteen variables had predictive value for hepatorenal syndrome occurrence in the univariate analysis: history of ascites, hepatomegaly, nutritional status, blood urea nitrogen level, serum creatinine concentration, serum sodium and potassium concentration, serum and urine osmolality, urinary sodium excretion, free water clearance after a water load, glomerular filtration rate, arterial pressure, plasma renin activity, plasma norepinephrine concentration, and esophageal varices. Neither etiology (alcoholic vs. nonalcoholic) nor the Child-Pugh score had predictive value. A multivariate analysis disclosed only three independent predictors of hepatorenal syndrome occurrence: low serum sodium concentration, high plasma renin activity, and absence of hepatomegaly.Conclusions:The hepatorenal syndrome is a relatively frequent complication in cirrhotic patients with ascites that is associated with an extremely short survival. Liver size, plasma renin activity, and serum sodium concentration are predictors of hepatorenal syndrome occurrence in these patients.