Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites
Evaluation of the Acute Kidney Injury Network criteria in hospitalized patients with cirrhosis and ascites
复制标题
DOI：
10.1016/j.jhep.2013.03.039
复制
发表时间：
2013-09-01
影响因子：
25.7
通讯作者：
Angeli, Paolo
中科院分区：
文献类型：
--
作者：
Piano, Salvatore;Rosi, Silvia;Angeli, Paolo
背景和目标：几年来，肝病学家将肝硬化患者的急性肾衰竭定义为血清肌酐（sCr）升高≥ 50%，最终值sCr > 1.5 mg/dl（常规标准）。最近，急性肾损伤网络（AKIN）基于sCr的绝对增加0.3mg/dl或sCr的百分比增加>= 50%（还提供从1至3的分期）将急性肾衰竭定义为急性肾损伤（阿基）。AKIN 1期定义为sCr增加>= 0.3 mg/dl或sCr增加>= 1.5倍至2倍。方法：以肝硬化腹水合并阿基的连续住院患者为研究对象，采用年龄和Child-Turcotte-Pugh评分模型对阿基的发生、发展进行预测。结果：常规标准比AKIN标准更能准确预测AKI的住院死亡率。增加AKIN分期进展或sCr阈值1.5 mg/dl进一步提高了该模型中AKIN标准的价值。更详细地说，AKIN 1期和sCr < 1.5 mg/dl的患者死亡率较低（p = 0.03），进展率较低（p = 0.01），改善率较高（p = 0.025）高于AKIN 1期和sCr >= 1.5 mg/dl的患者。常规标准预测肝硬化腹水患者住院死亡率较AKIN标准准确。在AKIN标准中增加AKIN分期的进展或sCr ≥ 1.5 mg/dl的临界值可提高其预后准确性。(C)2013年欧洲肝脏研究协会。由Elsevier B出版。V.保留所有权利。
Background & Aims: For several years hepatologists have defined acute renal failure in patients with cirrhosis as an increase in serum creatinine (sCr) >= 50% to a final value of sCr > 1.5 mg/dl (conventional criterion). Recently, the Acute Kidney Injury Network (AKIN) defined acute renal failure as acute kidney injury (AKI) on the basis of an absolute increase in sCr of 0.3 mg/dl or a percentage increase in sCr >= 50% providing also a staging from 1 to 3. AKIN stage 1 was defined as an increase in sCr >= 0.3 mg/dl or increase in sCr >= 1.5-fold to 2-fold from baseline. AKI diagnosed with the two different criteria was evaluated for the prediction of in-hospital mortality.Methods: Consecutive hospitalized patients with cirrhosis and ascites were included in the study and evaluated for the development of AKI.Results: Conventional criterion was found to be more accurate than AKIN criteria in improving the prediction of in-hospital mortality in a model including age and Child-Turcotte-Pugh score. The addition of either progression of AKIN stage or a threshold value for sCr of 1.5 mg/dl further improves the value of AKIN criteria in this model. More in detail, patients with AKIN stage 1 and sCr < 1.5 mg/dl had a lower mortality rate (p = 0.03), a lower progression rate (p = 0.01), and a higher improvement rate (p = 0.025) than patients with AKIN stage 1 and sCr >= 1.5 mg/dl.Conclusions: Conventional criterion is more accurate than AKIN criteria in the prediction of in-hospital mortality in patients with cirrhosis and ascites. The addition of either the progression of AKIN stage or the cut-off of sCr >= 1.5 mg/dl to the AKIN criteria improves their prognostic accuracy. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.