Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India.
Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India,
Dig Dis. 2020;38(4):335-343. doi: 10.1159/000504836. Epub 2019 Dec 12.
To study the clinical profile and predictors of acute kidney injury (AKI) in patients with decompensated cirrhosis.
This observational study was conducted at Himalayan Institute of Medical Sciences, Dehradun, India, on 175 consecutive patients with decompensated cirrhosis. Patients were studied for AKI as per International Club of Ascites-AKI criteria.
The prevalence of AKI was 40.6%, with prerenal AKI 67.6%, hepatorenal syndrome (HRS) 23.8%, intrinsic renal AKI 7%, and postrenal AKI 1.4%. Mean arterial pressure (MAP), platelet count, and serum albumin were significantly lower and total leucocyte count (TLC), blood urea nitrogen, serum creatinine (SCr), total bilirubin, aspartate aminotransferase, international normalized ratio, Child-Turcotte-Pugh (CTP) score, and model for end-stage liver disease (MELD) score higher in cirrhosis patients with AKI than without AKI (p < 0.05 each). MAP, hemoglobin, TLC, and SCr were significantly different in various types of AKI (p < 0.05 each). AKI had a significant association with CTP score, alcohol, spontaneous bacterial peritonitis (SBP), sepsis, and shock (p < 0.05 each). Type of AKI had significant association with SBP, sepsis, and shock (p < 0.05 each). Mortality occurred in 33.8% patients with AKI with 64.7% mortality in patients with HRS. Outcome had significant association with AKI, stage and type of AKI (p < 0.05 each). Multivariate analysis showed SBP, sepsis, and shock as independent predictors of AKI (p < 0.05 each).
AKI occurred commonly in patients with decompensated cirrhosis. Prerenal AKI and HRS were the most common types of AKI. SBP, sepsis, and shock were important predictors of AKI.
研究失代偿性肝硬化患者急性肾损伤（AKI）的临床特征和预测因素。
本观察性研究在印度德拉敦喜马拉雅医学科学研究所进行，共纳入 175 例连续失代偿性肝硬化患者。根据国际腹水俱乐部 AKI 标准对患者进行 AKI 研究。
AKI 的患病率为 40.6%，其中肾前性 AKI 占 67.6%，肝肾综合征（HRS）占 23.8%，特发性肾 AKI 占 7%，肾后性 AKI 占 1.4%。与无 AKI 的肝硬化患者相比，AKI 患者的平均动脉压（MAP）、血小板计数和血清白蛋白显著降低，白细胞总数（TLC）、血尿素氮、血清肌酐（SCr）、总胆红素、天门冬氨酸氨基转移酶、国际标准化比值、Child-Turcotte-Pugh（CTP）评分和终末期肝病模型（MELD）评分显著升高（p<0.05）。不同类型 AKI 患者的 MAP、血红蛋白、TLC 和 SCr 差异显著（p<0.05）。AKI 与 CTP 评分、酒精、自发性细菌性腹膜炎（SBP）、败血症和休克显著相关（p<0.05）。不同类型 AKI 与 SBP、败血症和休克显著相关（p<0.05）。AKI 患者中有 33.8%死亡，其中 HRS 患者的死亡率为 64.7%。结局与 AKI、AKI 分期和类型显著相关（p<0.05）。多变量分析显示，SBP、败血症和休克是 AKI 的独立预测因素（p<0.05）。
失代偿性肝硬化患者 AKI 发生率较高。肾前性 AKI 和 HRS 是最常见的 AKI 类型。SBP、败血症和休克是 AKI 的重要预测因素。
