蛋白尿可预测重症肝硬化患者的短期预后。

Proteinuria can predict short-term prognosis in critically ill cirrhotic patients.

作者信息

Lin Li-Yuan, Jenq Chang-Chyi, Liu Cheng-Sheng, Huang Chun-Sheng, Fan Pei-Chun, Chang Chih-Hsiang, Lee Shen-Yang, Chang Ming-Yang, Tian Ya-Chung, Hung Cheng-Chieh, Tsai Ming-Hung, Fang Ji-Tseng, Yang Chih-Wei, Chen Yung-Chang

机构信息

*Department of Nephrology, Kidney Research Center ‡Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei †Chang Gung University College of Medicine, Taoyuan, Taiwan.

出版信息

J Clin Gastroenterol. 2014 Apr;48(4):377-82. doi: 10.1097/MCG.0000000000000060.

DOI:10.1097/MCG.0000000000000060

PMID:24440941

Abstract

BACKGROUND AND AIM

Increasing evidence supports that proteinuria is a useful tool in several clinical situations. Cirrhotic patients with proteinuria admitted to intensive care units (ICUs) have high mortality rates. This study analyzed the outcomes of critically ill cirrhotic patients and determined the prognostic value of proteinuria.

METHODS

A total of 230 cirrhotic patients were admitted to the ICU of a hospital in Taiwan between March 2008 and February 2011. We prospectively collected data, including demographic parameters and clinical characteristics, of patients on day 1 of admission to the ICU and analyzed these variables as predictors of mortality.

RESULTS

The overall ICU, hospital, and 90-day mortality rates were 54%, 60%, and 63%, respectively. The patients with proteinuria had higher rates of acute kidney injury (84% vs. 53%, P<0.001), ICU death (60% vs. 25%, P<0.001), and 90-day mortality (79% vs. 40%, P<0.001). Patients with proteinuria had a hazard ratio for 90-day mortality of 2.800 (P<0.001; 95% CI, 1.927-4.069). Multivariate analysis showed that proteinuria and the Sequential Organ Failure Assessment score were predictors of short-term prognosis.

CONCLUSIONS

Proteinuria in critically ill cirrhotic patients is associated with increased complications of liver cirrhosis, ICU mortality, and poor short-term prognosis.

摘要

背景与目的

越来越多的证据支持蛋白尿在多种临床情况下是一种有用的指标。入住重症监护病房（ICU）的肝硬化合并蛋白尿患者死亡率很高。本研究分析了重症肝硬化患者的预后情况，并确定了蛋白尿的预后价值。

方法

2008年3月至2011年2月期间，共有230例肝硬化患者入住台湾一家医院的ICU。我们前瞻性地收集了患者入住ICU第1天的人口统计学参数和临床特征等数据，并将这些变量作为死亡率的预测指标进行分析。

结果

ICU总体死亡率、医院死亡率和90天死亡率分别为54%、60%和63%。有蛋白尿的患者急性肾损伤发生率更高（84%对53%，P<0.001）、ICU死亡率更高（60%对25%，P<0.001）以及90天死亡率更高（79%对40%，P<0.001）。有蛋白尿的患者90天死亡率的风险比为2.800（P<0.001；95%可信区间，1.927 - 4.069）。多变量分析显示，蛋白尿和序贯器官衰竭评估评分是短期预后的预测指标。