Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain.
Liver Int. 2018 Feb;38(2):285-294. doi: 10.1111/liv.13515. Epub 2017 Sep 12.
BACKGROUND & AIMS: Cellulitis is a common infection in patients with cirrhosis but its impact on progression of liver disease has been hardly addressed. This study examines the incidence of acute kidney injury (AKI), predictive factors and its impacts on mortality in cirrhotic patients hospitalized for cellulitis.
Retrospective data from cirrhotic patients hospitalized for cellulitis over the period January 2006 to September 2015 were analysed. AKI was defined according to revised criteria of the International Club of Ascites.
A total of 101 episodes of cellulitis were examined (70.3% men; mean age 60.6 ± 13.6 years). Of patients, 27% met criteria for acute on chronic liver failure (ACLF) (grade 1: 63%; grade 2: 22%; grade 3: 15%). AKI was recorded in 50.5% (type 1: 67%; type 2: 19%; type 3: 14%). AKI was present on admission in 21 of the 51 patients (41%) who developed it. In the remaining 30 patients (59%), AKI appeared during hospitalization and its development was associated with a MELD score >14 (70% vs 30%, P=.024). In-hospital mortality was 10% and all patients who died had AKI. A high MELD score on admission, AKI and ACLF were associated with in-hospital mortality (P<.05). One-month transplant-free survival was 84% (70% vs 98% in patients with and without AKI, P=.001).
In cirrhotic patients, cellulitis is a serious infection that often leads to AKI and ACLF. AKI is a strong predictor of mortality in this setting.
蜂窝织炎是肝硬化患者的常见感染，但它对肝病进展的影响尚未得到充分关注。本研究旨在探讨肝硬化患者因蜂窝织炎住院期间发生急性肾损伤（AKI）的发生率、预测因素及其对死亡率的影响。
分析了 2006 年 1 月至 2015 年 9 月期间因蜂窝织炎住院的肝硬化患者的回顾性数据。AKI 根据国际腹水俱乐部修订的标准定义。
共检查了 101 例蜂窝织炎发作（70.3%为男性；平均年龄 60.6±13.6 岁）。27%的患者符合急性慢加急性肝衰竭（ACLF）标准（1 级：63%；2 级：22%；3 级：15%）。50.5%的患者（1 型：67%；2 型：19%；3 型：14%）出现 AKI。在 51 例发生 AKI 的患者中，有 21 例（41%）在入院时即存在 AKI。在其余 30 例患者（59%）中，AKI 在住院期间出现，其发展与 MELD 评分>14 相关（70%比 30%，P=.024）。住院期间死亡率为 10%，所有死亡患者均存在 AKI。入院时高 MELD 评分、AKI 和 ACLF 与住院期间死亡率相关（P<.05）。无移植 1 个月存活率为 84%（AKI 患者为 70%，无 AKI 患者为 98%，P=.001）。
在肝硬化患者中，蜂窝织炎是一种严重的感染，常导致 AKI 和 ACLF。AKI 是该人群死亡的强有力预测因素。
