The attributable mortality of acute renal failure in critically ill patients with liver cirrhosis
The attributable mortality of acute renal failure in critically ill patients with liver cirrhosis
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DOI：
10.1007/s00134-005-2842-7
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发表时间：
2005-12-01
影响因子：
38.9
通讯作者：
Charbonneau, P
中科院分区：
文献类型：
--
作者：
du Cheyron, D;Bouchet, B;Charbonneau, P
目的：探讨肝硬化危重症患者急性肾功能衰竭（ARF）的预后和死亡风险。设计和背景：一项回顾性队列分析和两项独立的病例对照分析。患者：分别有41例和32例发生轻度和重度ARF的患者与ICU住院期间未发生ARF的哮喘患者相匹配（比例为1：2）。测量和结果：肝硬化ARF患者基线时MELD、APACHE II和SOFA评分高于无ARF患者。他们在ICU停留期间有更多的呼吸衰竭和心血管衰竭，在ICU停留时间更长，粗医院死亡率更高（65%对32%）。多变量生存分析确定ARF（风险比，HR，4.1）、酒精滥用或依赖、严重脓毒症或脓毒性休克为死亡的独立预测因素。在病例对照研究中，轻度和重度ARF均与死亡率独立相关（HR分别为2.6和4.2）。轻度ARF患者的肝硬化患者的死亡风险高于无ARF患者（相对危险度，RR，2.0）。重度ARF与匹配死亡风险增加（RR 2.6）、死亡率较高（51%）和风险调整后死亡率较高（2.1 vs. 0.9）相关。结论：肝硬化ICU患者的粗死亡率仍然较高。在这一特定人群中，ARF与死亡率过高相关，这取决于肾功能不全的严重程度。
Objective: To determine outcome and mortality risk related to acute renal failure (ARF) in critically ill patients with cirrhosis. Design and setting: A retrospective cohort analysis and two independent case-control analyses in a medical ICU. Patients: 41 and 32 patients who developed mild and severe ARF, respectively, matched (1:2 ratio) with cirrhotic patients without ARF during their ICU stay. Measurements and results: Cirrhotic patients with ARF had higher MELD, APACHE II, and SOFA scores at baseline that those without ARF. They had more respiratory failure and cardiovascular failure during ICU stay, longer stay in ICU, and a greater crude hospital mortality rate (65% vs. 32%). Multivariate survival analysis identified ARF (hazard ratio, HR, 4.1), alcohol abuse or dependency, and severe sepsis or septic shock as independent predictors of death. In case-control studies both mild and severe ARF were independently associated with mortality (HR, 2.6, and 4.2, respectively). Cirrhotic patients with mild ARF patients had a higher risk of death than those without ARF ( relative risk, RR, 2.0). Severe ARF was associated with an increase matched risk of death ( RR 2.6), higher mortality of 51%, and higher risk-adjusted mortality rate (2.1 vs. 0.9). Conclusions: ICU patients with liver cirrhosis still have a high crude mortality. In this specific population ARF is associated with an excess mortality, depending on the severity of renal dysfunction.