Terra Carlos, Guevara Mónica, Torre Aldo, Gilabert Rosa, Fernández Javier, Martín-Llahí Marta, Baccaro Maria E, Navasa Miquel, Bru Conxita, Arroyo Vicente, Rodés Juan, Ginès Pere
Liver Unit, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Gastroenterology. 2005 Dec;129(6):1944-53. doi: 10.1053/j.gastro.2005.09.024.
BACKGROUND & AIMS: Although renal failure is a common complication of sepsis and patients with cirrhosis frequently develop sepsis, there have been no studies specifically assessing renal function in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis. The aim of this study was to investigate prospectively the frequency, characteristics, and outcome of renal failure in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis.
One hundred six consecutive patients with cirrhosis and sepsis were studied prospectively. Patients with spontaneous bacterial peritonitis were excluded.
Twenty-nine out of 106 patients (27%) with cirrhosis and sepsis developed acute renal failure as compared with only 8 of 100 patients (8%) from a control group of cirrhotic patients without infection (P < .0001). Renal failure in the sepsis group was reversible in 22 (76%; 21% of all patients) patients and nonreversible in 7 (24%; 6% of all patients) patients. Renal failure was associated with impairment of effective arterial blood volume, without evidence of tubular damage. The occurrence and type of renal failure correlated strongly with mortality (mortality at 3 months: nonreversible renal failure, 100%; reversible renal failure, 55%; no renal failure, 13%). Among variables obtained at diagnosis of sepsis, the Model for End-Stage Liver Disease (MELD) score was the only independent predictive factor of mortality.
Renal failure is common in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis and is associated with arterial underfilling and renal vasoconstriction. Outcome is poor, even in the setting of reversible renal failure. The MELD score is the best prognostic marker of patients with cirrhosis and sepsis.
尽管肾衰竭是脓毒症的常见并发症，且肝硬化患者常发生脓毒症，但尚无专门评估非自发性细菌性腹膜炎所致肝硬化合并脓毒症患者肾功能的研究。本研究旨在前瞻性调查非自发性细菌性腹膜炎所致肝硬化合并脓毒症患者肾衰竭的发生率、特征及预后。
对106例连续性肝硬化合并脓毒症患者进行前瞻性研究。排除自发性细菌性腹膜炎患者。
106例肝硬化合并脓毒症患者中有29例（27%）发生急性肾衰竭，而100例无感染的肝硬化对照组患者中仅有8例（8%）发生急性肾衰竭（P <.0001）。脓毒症组中的22例（76%；占所有患者的21%）患者肾衰竭可逆转，7例（24%；占所有患者的6%）患者肾衰竭不可逆转。肾衰竭与有效动脉血容量受损有关，无肾小管损伤证据。肾衰竭的发生及类型与死亡率密切相关（3个月时死亡率：不可逆性肾衰竭为100%；可逆性肾衰竭为55%；无肾衰竭为13%）。在脓毒症诊断时获得的各项变量中，终末期肝病模型（MELD）评分是唯一独立的死亡率预测因素。
非自发性细菌性腹膜炎所致肝硬化合并脓毒症患者肾衰竭常见，且与动脉血容量不足和肾血管收缩有关。即使是可逆性肾衰竭，预后也较差。MELD评分是肝硬化合并脓毒症患者的最佳预后指标。
