Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
J Hepatol. 2010 Apr;52(4):523-8. doi: 10.1016/j.jhep.2010.01.009. Epub 2010 Feb 4.
BACKGROUND & AIMS: Serum creatinine, a component of the model for end-stage liver disease (MELD), is an important prognostic indicator in patients with end-stage liver disease (ESLD). In addition, serum sodium has recently been recognized as an important predictor of mortality in patients with ESLD. We investigate the role of serum creatinine and sodium, and glomerular filtration rate (GFR) as determinants of survival in patients with ESLD.
A prospective database was utilized to identify all adults listed for primary liver transplantation (LTx) at the Mayo Clinic, Rochester, between 1990 and 1999. GFR was measured by iothalamate clearance.
Among 837 patients listed for LTx, 660 had complete data including measured GFR. There was a significant association between GFR and survival after adjustment for MELD, with a linear rise in the risk of death as GFR decreased between 60 and 20ml/min/1.73m(2). Multivariable models showed that GFR is superior to creatinine in predicting mortality - a model consisting of total bilirubin (hazard ratio (HR)=2.17, p<0.01), INR (HR=3.26, p<0.01) and GFR (HR=0.42, p<0.01) was superior to MELD (chi-square 65.6 vs. 59.4, c-statistic 0.792 vs. 0.780). Serum sodium did not contribute to survival prediction when accurately measured GFR data were available.
Serum concentrations of creatinine and sodium in patients with end-stage liver disease reflect a reduction in renal function, the underlying event that decreases survival.
血清肌酐是终末期肝病模型（MELD）的一个组成部分，是终末期肝病（ESLD）患者的重要预后指标。此外，血清钠最近被认为是预测 ESLD 患者死亡率的重要指标。我们研究了血清肌酐和钠以及肾小球滤过率（GFR）在 ESLD 患者生存中的决定作用。
利用前瞻性数据库，确定了 1990 年至 1999 年期间在梅奥诊所罗切斯特分校接受原发性肝移植（LTx）的所有成年人。通过碘酞酸盐清除率测量 GFR。
在 837 例接受 LTx 名单的患者中，有 660 例有完整的数据，包括测量的 GFR。在调整 MELD 后，GFR 与生存率之间存在显著相关性，随着 GFR 在 60 至 20ml/min/1.73m 2 之间下降，死亡风险呈线性上升。多变量模型表明，GFR 优于肌酐预测死亡率-由总胆红素（危险比（HR）=2.17，p<0.01）、INR（HR=3.26，p<0.01）和 GFR（HR=0.42，p<0.01）组成的模型优于 MELD（卡方 65.6 与 59.4，c 统计量 0.792 与 0.780）。当可以获得准确测量的 GFR 数据时，血清钠对生存预测没有贡献。
终末期肝病患者的血清肌酐和钠浓度反映了肾功能的降低，而肾功能的降低降低了生存率。
