Gastroenterology and Digestive Endoscopy Section, Fundación Santa Fe de Bogotá, Bogota, Colombia.
Internal Medicine Department, Fundación Santa Fe de Bogotá, Bogota, Colombia.
PLoS One. 2020 Oct 20;15(10):e0239834. doi: 10.1371/journal.pone.0239834. eCollection 2020.
BACKGROUND & AIMS: Hepatorenal syndrome is a rare entity that is part of the complications of liver cirrhosis in its more severe stages. Without treatment, its mortality rate increases significantly. Terlipressin is considered to be the therapy of choice until the need of a liver transplant. The aim is to determine its prevalence, define patients' characteristics, triggers and 90-day survival, according to the type of managements established.
This was a retrospective cohort study conducted in Colombia. It included patients with cirrhosis and acute kidney injury who met hepatorenal syndrome criteria, reaching 28 patients from 2007 to 2015. Groups were categorized according the type of hepatorenal syndrome and treatment. Demographic and trigger factors were evaluated to characterize the population. Treatment outcomes with terlipressin vs norepinephrine were analyzed up to a 90-day survival, using log Rank test. Continuous variables needed Student's T and Mann Whitney's U tests and categorical variables, Chi2 test. A value of p <0.05 and a power of 85% was considered. The data was analyzed in the SPSS version 23 software.
117 patients with cirrhosis developed renal injury; of these 23.9% were diagnosed with Hepatorenal Syndrome (67.8% type1; 32.1% type2). The presence of ascites was 100% in HRS2 and 84% in HRS1 (p = 0.296). The main trigger in both types was paracentesis greater than 5 liters in the last 4 weeks (39.3%). In total, 35% of the patients received renal replacement therapy and 14% underwent a hepatic transplant. Type 1 was more frequent (63% received terlipressin; 21% norepinephrine). The total complete response was 36% (Type2 66.6% vs. Type1 18.7%) (p = 0.026). In contrast, the overall mortality was of 67.8% at 90-day of follow-up (89.4% Type1 vs. 22% Type2) (p = <0.001). We found a lower mortality rate in patients treated with terlipressin than treated with norepinephrine (p = 0.006).
There is scarce clinical and epidemiological information about this condition in Colombia. A significant difference between the two drugs cannot be stipulated due to the limitation in the sample size of our study. The general mortality at a 90-day follow-up was high, being higher in patients with HRS1. While the results of this study are suggestive of clinical information for HRS patients in the Colombian population, they should also be interpreted with caution, therefore further multicenter studies should be performed.
肝肾综合征是一种罕见的疾病，是肝硬化更严重阶段的并发症之一。如果不治疗，其死亡率会显著增加。特利加压素被认为是治疗肝肾综合征的首选药物，直到需要进行肝移植。本研究旨在根据所采用的治疗方法，确定其患病率、定义患者的特征、诱因和 90 天生存率。
这是一项在哥伦比亚进行的回顾性队列研究。共纳入 2007 年至 2015 年间 28 例符合肝肾综合征标准的肝硬化合并急性肾损伤患者。根据肝肾综合征的类型和治疗方法对患者进行分组。评估人口统计学和触发因素以描述人群特征。使用对数秩检验分析特利加压素与去甲肾上腺素治疗的结果，直至 90 天生存率。连续变量需要进行学生 t 检验和曼-惠特尼 U 检验，分类变量需要进行卡方检验。p 值<0.05，效能为 85%。数据在 SPSS 23 软件中进行分析。
117 例肝硬化患者发生了肾脏损伤，其中 23.9%被诊断为肝肾综合征（1 型 67.8%，2 型 32.1%）。2 型肝肾综合征患者腹水的发生率为 100%，1 型肝肾综合征患者腹水的发生率为 84%（p=0.296）。两种类型的主要诱因均为最近 4 周内腹腔穿刺放液>5 升（39.3%）。共有 35%的患者接受了肾脏替代治疗，14%的患者接受了肝移植。1 型患者更常接受特利加压素治疗（63%），而 21%的患者接受去甲肾上腺素治疗。总完全缓解率为 36%（2 型 66.6% vs. 1 型 18.7%）（p=0.026）。相比之下，90 天随访时的总死亡率为 67.8%（1 型 89.4% vs. 2 型 22%）（p<0.001）。我们发现，接受特利加压素治疗的患者死亡率低于接受去甲肾上腺素治疗的患者（p=0.006）。
在哥伦比亚，关于这种疾病的临床和流行病学信息很少。由于本研究样本量有限，不能确定这两种药物之间存在显著差异。90 天随访时的总体死亡率较高，1 型肝肾综合征患者的死亡率更高。虽然本研究结果提示了肝肾综合征患者在哥伦比亚人群中的临床信息，但也应谨慎解释，因此应进一步开展多中心研究。
