Policlinico IRCCS San Donato, University of Milan, Italy.
J Hepatol. 2011 Dec;55(6):1241-8. doi: 10.1016/j.jhep.2011.03.012. Epub 2011 Apr 13.
BACKGROUND & AIMS: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with ascites. The International Ascites Club recommended strict diagnostic criteria and treatment with vasoconstrictors and albumin. Aim of this prospective cohort study was to investigate the prevalence of HRS, diagnostic criteria, treatment and 3-month outcome in the daily-clinical-practice.
Two-hundred-fifty-three patients with cirrhosis and renal failure consecutively admitted to 21 Italian hospitals were recruited.
The prevalence of HRS was 45.8% (30% type-1 and 15.8% type-2). In 36% of cases HRS was presumed because not all diagnostic criteria could be fulfilled. In 8% of cases HRS was superimposed on an organic nephropathy. Patients with HRS type-1 were younger and showed higher leukocyte count, higher respiratory rates, and worse liver function scores. Sixty-four patients with HRS type-1 received vasoconstrictors (40 terlipressin and 24 midodrine/octreotide). A complete response was obtained in 19 cases (30%) and a partial response in 13 (20%). Age was the only independent predictor of response (p=0.033). Three-month survival of patients with HRS type-1 was 19.7%. Survival was better in patients who responded to therapy. Age (p=0.017), bilirubin (p=0.012), and creatinine increase after diagnostic volume expansion (p=0.02) independently predicted death. The mortality rate was 97% among patients with at least two negative predictors.
The diagnostic criteria of HRS in our daily-clinical-practice could not be completely fulfilled in one third of cases. The treatment with vasoconstrictors and albumin was widely implemented. Mortality was strongly predicted by simple baseline variables.
肝肾综合征（HRS）是肝硬化伴腹水的严重并发症。国际腹水俱乐部推荐了严格的诊断标准和血管收缩剂及白蛋白治疗方法。本前瞻性队列研究的目的是在日常临床实践中调查 HRS 的患病率、诊断标准、治疗方法和 3 个月的转归。
连续招募了 21 家意大利医院的 253 名肝硬化合并肾衰竭患者。
HRS 的患病率为 45.8%（1 型 30%，2 型 15.8%）。在 36%的病例中，由于并非所有诊断标准都能得到满足，因此推测存在 HRS。在 8%的病例中，HRS 是在器质性肾病的基础上发生的。1 型 HRS 患者更年轻，白细胞计数更高，呼吸频率更快，肝功能评分更差。64 例 1 型 HRS 患者接受了血管收缩剂治疗（40 例特利加压素和 24 例米多君/奥曲肽）。19 例（30%）获得完全缓解，13 例（20%）获得部分缓解。年龄是唯一独立的反应预测因素（p=0.033）。1 型 HRS 患者 3 个月的生存率为 19.7%。对治疗有反应的患者生存率更好。年龄（p=0.017）、胆红素（p=0.012）和诊断性容量扩张后肌酐升高（p=0.02）是独立的死亡预测因素。至少有两个阴性预测因素的患者死亡率为 97%。
在我们的日常临床实践中，HRS 的诊断标准有三分之一无法完全满足。血管收缩剂和白蛋白治疗广泛应用。简单的基线变量可强烈预测死亡率。
