Serra M A, Puchades M J, Rodríguez F, Escudero A, del Olmo J A, Wassel A H, Rodrigo J M
Service of Hepatology, Hospital Clínico Universitario, University of Valencia, ES-46010 Valencia, Spain.
Scand J Gastroenterol. 2004 Nov;39(11):1149-53. doi: 10.1080/00365520410008024.
The purpose of this study was to assess whether serum creatinine concentration alone or associated with other biological parameters was an independent predictor of short-term mortality in patients with decompensated cirrhosis.
A total of 212 consecutive episodes of decompensated cirrhosis in patients admitted to the hospital between January 1999 and December 2001 were reviewed retrospectively. Depending on a serum creatinine concentration equal to or greater than 1.5 mg/dL at the time of admission, patients were divided into decompensated cirrhosis with renal failure (101 episodes in 59 patients, aged 69.8 +/- 10 years) and without renal failure (111 episodes in 61 patients, aged 64.5 +/- 13 years). Outcome (alive, death) during the episode of decompensation of liver disease and outcome at 90 days after admission were assessed.
Differences in the frequency of variables according to outcome in the overall episodes of decompensated cirrhosis with and without renal failure showed significant differences between patients who died and those who were alive both at hospital discharge and at 90 days in serum bilirubin, Child-Pugh score, MELD (model for end-stage liver disease) score, and serum creatinine levels. In the multivariate analysis, serum creatinine was not an independent predictor of outcome. The prediction accuracy according to the area under the ROC (receiver operating characteristic) curve was greater for the MELD scale than for serum creatinine.
Serum creatinine concentration is a parameter that should be included in the prognostic assessment of patients with decompensated cirrhosis, but should be combined with other specific parameters of liver function, such as bilirubin, albumin, and the international normalized ratio (INR) for prothrombin time.
本研究旨在评估单独的血清肌酐浓度或与其他生物学参数相关联时，是否为失代偿期肝硬化患者短期死亡率的独立预测指标。
回顾性分析了1999年1月至2001年12月期间收治入院的212例连续性失代偿期肝硬化患者。根据入院时血清肌酐浓度是否等于或大于1.5mg/dL，将患者分为伴有肾衰竭的失代偿期肝硬化（59例患者共101次发作，年龄69.8±10岁）和不伴有肾衰竭的失代偿期肝硬化（61例患者共111次发作，年龄64.5±13岁）。评估了肝病失代偿期发作期间的结局（存活、死亡）以及入院后90天的结局。
在伴有和不伴有肾衰竭的失代偿期肝硬化总体发作中，根据结局的变量频率差异显示，在出院时和90天时，死亡患者与存活患者在血清胆红素、Child-Pugh评分、终末期肝病模型（MELD）评分和血清肌酐水平方面存在显著差异。在多变量分析中，血清肌酐不是结局的独立预测指标。根据ROC（受试者工作特征）曲线下面积，MELD量表的预测准确性高于血清肌酐。
血清肌酐浓度是失代偿期肝硬化患者预后评估中应纳入的一个参数，但应与肝功能的其他特定参数，如胆红素、白蛋白和凝血酶原时间的国际标准化比值（INR）相结合。
