Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome
Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome
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DOI：
10.1016/j.cgh.2018.01.035
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发表时间：
2018-11-01
影响因子：
12.6
通讯作者：
Angeli, Paolo
中科院分区：
文献类型：
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作者：
Piano, Salvatore;Schmidt, Hartmut H.;Angeli, Paolo
背景与目的：1型肝肾综合征（HRS）是肝硬化患者发生肾功能衰竭的最高风险类型。特利加压素和白蛋白是1型HRS的有效治疗方法。然而，急性肝功能衰竭（ACLF）分级对治疗反应的影响尚不清楚。我们的目的是确定1型HRS患者特利加压素和白蛋白治疗反应的相关因素（治疗结束时血清肌酐水平降至1.5 mg/dL以下）和HRS诊断后90天内死亡相关因素（90天死亡率）。我们对2007年2月至2016年1月期间接受特利加压素和白蛋白治疗的4个不同HRS连续患者队列进行了回顾性分析，欧洲的研究中心（共298例患者）。我们分析了治疗前和治疗期间收集的人口统计学、临床和实验室数据;患者随访至死亡、肝移植或HRS诊断后90天。在1级ACLF患者中，60%对治疗有反应;在2级ACLF患者中，48%有反应，在3级ACLF患者中，29%有反应（级别间比较P <0.001）。在多变量分析中，基线血清肌酐水平（比值比，0.23; P = 0.001）和ACLF分级（比值比，0.63; P = 0.01）与治疗反应独立相关。患者年龄（风险比[HR]，1.05; P
BACKGROUND & AIMS: Type 1 hepatorenal syndrome (HRS) is the most high-risk type of renal failure in patients with cirrhosis. Terlipressin and albumin are effective treatments for type 1 HRS. However, the effects of acute on chronic liver failure (ACLF) grade on response to treatment are not clear. We aimed to identify factors associated with response to treatment with terlipressin and albumin in patients with type 1 HRS (reduction in serum level of creatinine to below 1.5 mg/dL at the end of treatment) and factors associated with death within 90 days of HRS diagnosis (90-day mortality).METHODS: We performed a retrospective analysis of 4 different cohorts of consecutive patients with HRS treated with terlipressin and albumin from February 2007 through January 2016 at medical centers in Europe (total, 298 patients). We analyzed demographic, clinical, and laboratory data collected before and during treatment; patients were followed until death, liver transplantation, or 90 days after HRS diagnosis.RESULTS: Response to treatment was observed in 53% of patients. Of patients with grade 1 ACLF, 60% responded to treatment; among those with grade 2 ACLF, 48% responded, and among those with grade 3 ACLF, 29% responded (P < .001 for comparison between grades). In multivariate analysis, baseline serum level of creatinine (odds ratio, 0.23; P = .001) and ACLF grade (odds ratio, 0.63; P = .01) were independently associated with response to treatment. Patient age (hazard ratio [HR], 1.05; P