终末期肾病是肝硬化食管静脉曲张破裂出血患者死亡的危险因素吗？

Is end stage renal disease a risk factor for the mortality of cirrhotic patients with esophageal variceal bleeding?

作者信息

Hung Tsung-Hsing, Tseng Chih-Wei, Tseng Kuo-Chih, Hsieh Yu-Hsi, Tsai Chih-Chun, Tsai Chen-Chi

出版信息

Hepatogastroenterology. 2014 Oct;61(135):1871-5.

Abstract

BACKGROUND/AIMS: End stage renal disease (ESRD) patients are prone to have bleeding due to uremic platelet dysfunction. However, it is still unknown if ESRD is a risk factor for the mortality of cirrhotic patients with esophageal variceal bleeding (EVB).

METHODOLOGY

The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to enroll 6740 cirrhotic patients who were hospitalized with EVB from January 1 to December 31, 2007. The patients were matched with individuals from a national mortality database to calculate their survival time.

RESULTS

Of all, 418 patients had renal function impairment (RFI) during their hospitalization. There were 209 (50%) patients with acute renal failure (ARF), and 110 (26.3%) patients with ESRD. The adjusted hazard ratios (HR) of ARF for 6-week and 1-year mortalities of cirrhotic patients with EVB were 4.90 (P<0.001) and 4.34 (P<0.001), compared to the non-RFI group. However, the adjusted HRs of ESRD for 6-week and 1-year mortalities were 1.19 (P=0.404) and 1.50 (P<0.001), compared to the non-RFI impairment group.

CONCLUSION

ESRD is associated with 1-year mortality, but not a risk factor for 6-week mortality in cirrhotic patients with EVB.

摘要

背景/目的：终末期肾病（ESRD）患者由于尿毒症血小板功能障碍容易出血。然而，ESRD是否为肝硬化合并食管静脉曲张破裂出血（EVB）患者死亡的危险因素仍不清楚。

方法

利用源自台湾全民健康保险计划的全民健康保险数据库，纳入2007年1月1日至12月31日因EVB住院的6740例肝硬化患者。将这些患者与国家死亡率数据库中的个体进行匹配，以计算他们的生存时间。

结果

总共418例患者在住院期间出现肾功能损害（RFI）。其中209例（50%）为急性肾衰竭（ARF）患者，110例（26.3%）为ESRD患者。与非RFI组相比，肝硬化合并EVB患者6周和1年死亡率的ARF校正风险比（HR）分别为4.90（P<0.001）和4.34（P<0.001）。然而，与非RFI损害组相比，ESRD患者6周和1年死亡率的校正HR分别为1.19（P=0.404）和1.50（P<0.001）。