Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Nov;83(11):984-990. doi: 10.1097/JCMA.0000000000000422.
Cardiovascular dysfunction in cirrhotic patients affects survival and the development of cirrhotic complications. We aimed to evaluate potential echocardiographic parameters to predict mortality and acute kidney injury (AKI) in cirrhotic patients.
A total of 103 cirrhotic patients who underwent echocardiography between February 2009 and August 2016 in Taipei Veterans General Hospital were retrospectively enrolled. Cardiac function was evaluated using transthoracic two-dimensional echocardiography with tissue Doppler imaging. Cox hazard regression analysis was used for assessing predictors for 1-year mortality and AKI within 1 year.
Baseline echocardiographic parameters were similar between survivors (n = 92) and nonsurvivors (n = 11). Lower serum levels of albumin, as well as higher albumin-bilirubin (ALBI) scores, Child-Pugh scores, and model for end-stage liver disease scores were observed in nonsurvivors. Cox proportional hazard regression analysis revealed Child-Pugh score as the only predictor of 1-year mortality. Baseline serum creatinine (Cr) > 1.5 mg/dL, total bilirubin > 2 mg/dL, and a higher E/e' ratio predict occurrence of AKI within 1 year. Among patients with serum Cr < 1.5 mg/dL, an increased atrial filling velocity and higher ALBI scores predict AKI occurrence within 1 year.
Severity of underlying liver disease but not echocardiographic parameters predicts 1-year mortality in cirrhosis. Early echocardiographic signs of diastolic dysfunction and higher ALBI scores may predict development of AKI in cirrhotic patients with serum Cr < 1.5 mg/dL.
肝硬化患者的心血管功能障碍会影响生存和肝硬化并发症的发展。我们旨在评估潜在的超声心动图参数，以预测肝硬化患者的死亡率和急性肾损伤（AKI）。
回顾性纳入 2009 年 2 月至 2016 年 8 月期间在台北荣民总医院接受超声心动图检查的 103 例肝硬化患者。使用经胸二维超声心动图和组织多普勒成像评估心功能。Cox 风险回归分析用于评估 1 年死亡率和 1 年内 AKI 的预测因素。
幸存者（n=92）和非幸存者（n=11）的基线超声心动图参数相似。非幸存者的血清白蛋白水平较低，白蛋白-胆红素（ALBI）评分、Child-Pugh 评分和终末期肝病模型评分较高。Cox 比例风险回归分析显示，Child-Pugh 评分是 1 年死亡率的唯一预测因素。基线血清肌酐（Cr）>1.5mg/dL、总胆红素>2mg/dL 和较高的 E/e'比值预测 1 年内发生 AKI。在血清 Cr <1.5mg/dL 的患者中，增加的心房充盈速度和较高的 ALBI 评分预测 1 年内 AKI 的发生。
基础肝病的严重程度而非超声心动图参数预测肝硬化患者的 1 年死亡率。早期舒张功能障碍的超声心动图迹象和较高的 ALBI 评分可能预测血清 Cr <1.5mg/dL 的肝硬化患者发生 AKI。
