肝硬化患者入住重症监护病房：急性肾衰竭对死亡率的影响。

Cirrhotics admitted to intensive care unit: the impact of acute renal failure on mortality.

机构信息

Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital, Hampstead, London NW3 2QG, UK.

出版信息

Eur J Gastroenterol Hepatol. 2009 Jul;21(7):744-50. doi: 10.1097/MEG.0b013e328308bb9c.

DOI:10.1097/MEG.0b013e328308bb9c

PMID:20160527

Abstract

BACKGROUND

The exact role of renal dysfunction in critically ill cirrhotics admitted to an intensive care unit (ICU) has not been assessed extensively.

AIM

To evaluate the impact of acute renal failure (ARF) on 6 weeks mortality in cirrhotics admitted to ICU.

PATIENTS/METHODS: Three hundred and twelve cirrhotics (182 male, mean age 49.6+/-11.5 years) were consecutively admitted during the study period. The patients (n=128, 40%) (group 1) with ARF on admission and/or during ICU were compared with the patients whose ICU stay was not complicated with ARF (n=184, 60%) (group 2). At admission, 40 variables were available, whereas Child-Turcotte-Pugh, Model for End-stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment and Failure Organ System scores on admission, were evaluated and compared by receiver operating characteristic curves.

RESULTS

Group 1, compared with group 2 patients, had longer ICU stay (7 vs. 4 days, P=0.04) and required cardiovascular support more frequently with inotropes (90 vs. 75%), (P<0.001). Mortality was significantly higher in group 1, compared with group 2 (91 vs. 47%, P<0.001). At admission, group 1, compared with group 2, had significantly higher Child-Turcotte-Pugh (12 vs. 11), Acute Physiology and Chronic Health Evaluation II (22 vs. 17), Model for End-stage Liver Disease (31 vs. 21), Sequential Organ Failure Assessment (13 vs. 9) and Failure Organ System (3 vs. 2) scores (P<0.001). In group 1, factors independently associated with mortality were: higher FiO2 (P=0.044), bilirubin (P=0.021) and creatinine (P=0.002) on admission. Mortality was not significantly different between those with ARF on admission, and those who developed ARF during ICU stay.

CONCLUSION

ARF at admission or during ICU stay is strongly predictive of mortality, which is high, despite supportive therapeutic interventions. Preventive measures are needed to prevent ARF, to improve prognosis.

摘要

背景

肾功能不全在重症监护病房（ICU）收治的肝硬化患者中的确切作用尚未得到广泛评估。

目的

评估急性肾衰竭（ARF）对 ICU 收治的肝硬化患者 6 周死亡率的影响。

患者/方法：本研究期间连续收治了 312 名肝硬化患者（182 名男性，平均年龄 49.6+/-11.5 岁）。将入院时和/或 ICU 期间发生 ARF 的患者（n=128，40%）（第 1 组）与未发生 ARF 的患者（n=184，60%）（第 2 组）进行比较。入院时，有 40 个变量可供使用，通过接受者操作特征曲线评估和比较入院时的 Child-Turcotte-Pugh、终末期肝病模型、急性生理学和慢性健康评估 II、序贯器官衰竭评估和衰竭器官系统评分。

结果

与第 2 组患者相比，第 1 组患者 ICU 住院时间更长（7 天 vs. 4 天，P=0.04），更频繁地需要心血管支持，需要使用正性肌力药（90% vs. 75%）（P<0.001）。第 1 组死亡率明显高于第 2 组（91% vs. 47%，P<0.001）。入院时，第 1 组患者的 Child-Turcotte-Pugh（12 分 vs. 11 分）、急性生理学和慢性健康评估 II（22 分 vs. 17 分）、终末期肝病模型（31 分 vs. 21 分）、序贯器官衰竭评估（13 分 vs. 9 分）和衰竭器官系统（3 分 vs. 2 分）评分均显著高于第 2 组（P<0.001）。第 1 组中，与死亡率相关的独立因素是：入院时 FiO2（P=0.044）、胆红素（P=0.021）和肌酐（P=0.002）较高。入院时发生 ARF 与 ICU 期间发生 ARF 的患者死亡率无显著差异。