Shetty Shiran, Nagaraju Shankar Prasad, Shenoy Srinivas, Attur Ravindra Prabhu, Rangaswamy Dharshan, Rao Indu R, Mateti Uday Venkat, Parthasarathy Rajeevalochana
Department of Gastroenterology, Kasturba Medical College, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, 576 104, India.
Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Tiger Circle Road, Madhav Nagar, Manipal, 576 104, India.
Indian J Gastroenterol. 2018 May;37(3):248-254. doi: 10.1007/s12664-018-0867-4. Epub 2018 Jul 17.
Acute kidney injury (AKI) is a common complication of liver cirrhosis and is associated with poor survival. We studied the clinical profile and predictors of in-hospital mortality in patients with cirrhosis of the liver with AKI.
This retrospective cohort study examined patients at a tertiary care hospital. AKI staging was done based on the new 2015 Ascites Club Criteria. Patients were grouped into three types of AKI: pre-renal azotemia (PRA), hepatorenal syndrome (HRS), and acute tubular necrosis (ATN).
Data of 123 patients with cirrhosis and AKI were analyzed. Most patients had AKI stage 3 (57.7%). ATN (42.3%) and HRS (43.9) were the predominant types of AKI followed by PRA (13.8%). The overall in-hospital mortality in our study was 44.7%. The mortality increased with increasing severity of AKI (p = 0.0001) and was the highest in AKI stage 3 (p = 0.001) and those who required hemodialysis (p = 0.001). There was a significant in-hospital mortality in patients with ATN and HRS in comparison to PRA (p = 0.001). On multivariate analysis, the factors predicting in-hospital mortality were AKI stage 3, and oliguria (p = 0.0001).
Acute kidney injury in cirrhosis of liver carries high in-hospital mortality. Pre-renal AKI has a better survival compared to ATN and HRS. The higher stage of AKI at presentation and the presence of oliguria are two important predictors of in-hospital mortality.
急性肾损伤（AKI）是肝硬化的常见并发症，与生存率低相关。我们研究了肝硬化合并AKI患者的临床特征及院内死亡的预测因素。
这项回顾性队列研究对一家三级医疗中心的患者进行了检查。AKI分期根据新的2015年腹水俱乐部标准进行。患者被分为三种类型的AKI：肾前性氮质血症（PRA）、肝肾综合征（HRS）和急性肾小管坏死（ATN）。
分析了123例肝硬化合并AKI患者的数据。大多数患者为AKI 3期（57.7%）。ATN（42.3%）和HRS（43.9%）是AKI的主要类型，其次是PRA（13.8%）。我们研究中的总体院内死亡率为44.7%。死亡率随AKI严重程度的增加而升高（p = 0.0001），在AKI 3期（p = 0.001）和需要血液透析的患者中最高（p = 0.001）。与PRA相比，ATN和HRS患者的院内死亡率显著更高（p = 0.001）。多因素分析显示，预测院内死亡的因素为AKI 3期和少尿（p = 0.0001）。
肝硬化合并急性肾损伤的患者院内死亡率高。与ATN和HRS相比，肾前性AKI的生存率更高。就诊时AKI的更高分期和少尿是院内死亡的两个重要预测因素。
