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肝硬化患者非自发性细菌性腹膜炎细菌感染引起的肾功能障碍:发生率及危险因素。

Renal Dysfunction Induced by Bacterial Infection other than Spontaneous Bacterial Peritonitis in Patients with Cirrhosis: Incidence and Risk Factor.

机构信息

Department of Inetrnal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

出版信息

Gut Liver. 2009 Dec;3(4):292-7. doi: 10.5009/gnl.2009.3.4.292. Epub 2009 Dec 31.

Abstract

BACKGROUND/AIMS: Deterioration of renal function in cirrhotic patients with spontaneous bacterial peritonitis (SBP) is a predictor for in-hospital mortality; however, the clinical significance of renal dysfunction during bacterial infection other than SBP is unknown. The aim of this study was to investigate the prevalence and clinical significance of renal dysfunction due to bacterial infections other than SBP in patients with liver cirrhosis.

METHODS

Retrospective data from inpatients with bacterial infections other than SBP were analyzed.

RESULTS

Eighty patients were recruited for the analysis. The types of infections included that of urinary tract (37.5%), pneumonia (23.8%), biliary tract (20%), cellulitis (12.5%), and bacteremia of unknown origin (6.3%). Renal dysfunction developed in 29 patients (36.3%), of which 11 patients had irreversible renal dysfunction. The initial MELD score, neutrophil count, albumin, and blood pressure were significant risk factors in the univariate analysis, whereas only the MELD score was an independent risk factor for the development of renal dysfunction (p<0.001) after multivariate analysis.

CONCLUSIONS

The prevalence of renal dysfunction during bacterial infection other than SBP in patients with liver cirrhosis was 36.3%, and its development was related to the severity of the liver disease. Occurrence of irreversible renal dysfunction seemed to affect the prognosis of these patients.

摘要

背景/目的:肝硬化自发性细菌性腹膜炎(SBP)患者肾功能恶化是住院死亡率的预测因素;然而,除 SBP 以外的细菌感染导致的肾功能障碍的临床意义尚不清楚。本研究旨在探讨肝硬化患者除 SBP 以外的细菌感染导致的肾功能障碍的发生率和临床意义。

方法

分析了非 SBP 细菌感染住院患者的回顾性数据。

结果

共纳入 80 例患者进行分析。感染类型包括尿路感染(37.5%)、肺炎(23.8%)、胆道感染(20%)、蜂窝织炎(12.5%)和不明原因菌血症(6.3%)。29 例(36.3%)患者出现肾功能障碍,其中 11 例患者出现不可逆性肾功能障碍。单因素分析中,初始 MELD 评分、中性粒细胞计数、白蛋白和血压是肾功能障碍的显著危险因素,而多因素分析后只有 MELD 评分是肾功能障碍发生的独立危险因素(p<0.001)。

结论

肝硬化患者除 SBP 以外的细菌感染时肾功能障碍的发生率为 36.3%,其发生与肝病严重程度有关。不可逆性肾功能障碍的发生似乎影响了这些患者的预后。

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