肾衰竭和肝硬化：死亡率和预后的系统评价。
Renal failure and cirrhosis: a systematic review of mortality and prognosis.
机构信息
The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery - University College London and Royal Free Hospital, London, UK.
出版信息
J Hepatol. 2012 Apr;56(4):810-8. doi: 10.1016/j.jhep.2011.10.016. Epub 2011 Dec 13.
BACKGROUND & AIMS: To evaluate renal failure (RF) in cirrhosis to determine and quantify its prognostic significance.
METHODS
Studies were identified by MEDLINE, EMBASE, Cochrane, ISI Web of Science (1977-2010); search terms included renal failure, mortality, and cirrhosis. Included studies (n=74) reported >10 patients and mortality data (8088 patients). Mortality at 1, 3, and 12 months was evaluated with respect to Child-Pugh score, serum creatinine, ascites, ICU status or sepsis, prospective study design, and publication year. Pooled odds ratio (POR) for death was compared for RF vs. non-RF (5668 patients).
RESULTS
Overall median mortality for RF patients was 67%: 58% at 1 month and 63% (IQR 54-79) at 12 months. POR for death RF vs. non-RF patients was 7.6 (95%CI 5.4-10.8). Overall mortality before 2005 (1264 patients) was 74% and after 2005 (2833 patients) was 63% with a marked reduction only at 30 days (71% vs. 52%).
CONCLUSIONS
This study provides a measure of the increased risk of death in cirrhosis with renal failure. RF increases mortality 7-fold, with 50% of patients dying within one month. Preventative strategies for RF are needed.
背景与目的
评估肝硬化伴肾衰竭（RF）以确定和量化其预后意义。
方法
通过 MEDLINE、EMBASE、Cochrane、ISI Web of Science（1977-2010 年）进行文献检索，检索词包括肾衰竭、死亡率和肝硬化。纳入的研究（n=74）报告了＞10 例患者和死亡率数据（8088 例患者）。根据 Child-Pugh 评分、血清肌酐、腹水、ICU 状态或感染、前瞻性研究设计和出版年份评估 1、3 和 12 个月的死亡率。RF 与非-RF（5668 例患者）患者的死亡合并比值比（POR）进行比较。
结果
RF 患者的总体中位死亡率为 67%：1 个月时为 58%，12 个月时为 63%（IQR 54-79）。RF 与非-RF 患者的死亡 POR 为 7.6（95%CI 5.4-10.8）。2005 年前（1264 例患者）的总体死亡率为 74%，2005 年后（2833 例患者）的死亡率为 63%，仅在 30 天时有明显下降（71% vs. 52%）。
结论
本研究提供了肝硬化伴肾衰竭患者死亡风险增加的衡量标准。RF 使死亡率增加了 7 倍，50%的患者在一个月内死亡。需要制定针对 RF 的预防策略。
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