UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and University College London, London, UK.
Department of Nuclear Medicine, Royal Free Hospital, London, UK.
Hepatology. 2017 Feb;65(2):582-591. doi: 10.1002/hep.28891. Epub 2016 Nov 29.
Current expressions based on serum creatinine concentration overestimate kidney function in cirrhosis, leading to significant differences between "true" and calculated glomerular filtration rate (GFR). We compared the performance of the four-variable and six-variable Modification of Diet in Renal Disease and chronic kidney disease epidemiology with "true," or measured, GFR (mGFR) and the impact of this difference on Model for End-Stage Liver Disease (MELD) calculation. We subsequently developed and validated a GFR equation specifically for cirrhosis and compared the performance of the new derived formula with existing GFR formulae. We included 469 consecutive patients who had a transplant assessment between 2011 and 2014. mGFR was measured using plasma isotope clearance according to a technique validated in patients with ascites. A corrected creatinine was derived from the mGFR after application of the Modification of Diet in Renal Disease formula. Subsequently, a corrected MELD was calculated and compared with the conventionally calculated MELD. Stepwise multiple linear regression was used to derive a GFR equation. This was compared with the mGFR in independent external and internal validation sets of 82 and 174 patients with cirrhosis, respectively. A difference >20 mL/minute/1.73 m between existing formulae and mGFR was observed in 226 (48.2%) patients. The corrected MELD score was ≥3 points higher in 177 (37.7%) patients. The predicted equation (r = 74.6%) was GFR = 45.9 × (creatinine ) × (urea ) × (international normalized ratio ) × (age [Corrected November 29, 2016: originally written as "age-129."]) × (sodium ) × 0.809 (if female) × 0.92 (if moderate/severe ascites). An online calculator is available at http://rfh-cirrhosis-gfr.ucl.ac.uk. The model was a good fit and showed the greatest accuracy compared to that of existing formulae.
We developed and validated a new accurate model for GFR assessment in cirrhosis, the Royal Free Hospital cirrhosis GFR, using readily available variables; this remains to be tested and incorporated in prognostic scores in patients with cirrhosis. (Hepatology 2017;65:582-591).
目前基于血清肌酐浓度的表达式高估了肝硬化患者的肾功能，导致“真实”和计算肾小球滤过率（GFR）之间存在显著差异。我们比较了四种变量和六种变量的肾脏病饮食改良公式和慢性肾脏病流行病学与“真实”或测量肾小球滤过率（mGFR）的表现，并比较了这种差异对终末期肝病模型（MELD）计算的影响。随后，我们专门为肝硬化开发并验证了一个 GFR 方程，并将新得出的公式与现有的 GFR 公式的性能进行了比较。我们纳入了 2011 年至 2014 年间进行移植评估的 469 例连续患者。mGFR 使用根据腹水患者验证的血浆同位素清除率来测量。根据肾脏病饮食改良公式应用后，从 mGFR 中得出校正肌酐。随后，计算校正后的 MELD 并与常规计算的 MELD 进行比较。逐步多元线性回归用于推导 GFR 方程。将其与分别患有肝硬化的 82 名和 174 名独立外部和内部验证组的 mGFR 进行比较。在 226 名（48.2%）患者中，现有的公式与 mGFR 之间的差异>20 mL/min/1.73 m。在 177 名（37.7%）患者中，校正后的 MELD 评分高 3 分以上。预测方程（r = 74.6%）为 GFR = 45.9×（肌酐）×（尿素）×（国际标准化比值）×（年龄[校正于 2016 年 11 月 29 日：最初写为“age-129”。]）×（钠）×0.809（如果女性）×0.92（如果有中度/大量腹水）。一个在线计算器可在 http://rfh-cirrhosis-gfr.ucl.ac.uk 获得。该模型拟合良好，与现有的公式相比，具有最高的准确性。
我们使用易于获得的变量开发并验证了一种新的用于肝硬化 GFR 评估的准确模型，即皇家自由医院肝硬化 GFR；这仍有待在肝硬化患者的预后评分中进行测试和纳入。（Hepatology 2017；65：582-591）。
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