Service d'Hépatologie, Hôpital Rangueil, Fédération Hospitalo-Universitaire IMPACT, CHU de Toulouse, et Université Toulouse 3 - Paul Sabatier, 1 Av. du Professeur Jean Poulhès, 31400 Toulouse, France.
Service d'Hépatologie, Hôpital Rangueil, Fédération Hospitalo-Universitaire IMPACT, CHU de Toulouse, et Université Toulouse 3 - Paul Sabatier, 1 Av. du Professeur Jean Poulhès, 31400 Toulouse, France.
Clin Res Hepatol Gastroenterol. 2022 Apr;46(4):101822. doi: 10.1016/j.clinre.2021.101822. Epub 2021 Oct 28.
Acute kidney injury (AKI) is common in patients with cirrhosis. In 2015, the International Club of Ascites (ICA) proposed new definitions of AKI in order to improve the prediction of outcomes. Our aim was to assess the prevalence and prognostic value of ICA 2015 - AKI criteria in hospitalised patients with cirrhosis.
We prospectively collected data from 405 consecutive cirrhotic patients admitted to the hospital between November 2016 and November 2017. AKI was diagnosed at inclusion according to ICA 2015 criteria, and was assessed to predict 30-day and 90-day in-hospital mortality.
AKI was diagnosed in 78 (19.3%) patients. AKI was independently associated with 90-day death (HR 7.61; 95% CI 4.75-12.19; p < 0.001). In hospital, 30-day and 90-day survival was lower in the group of patients with AKI compared to the group with no AKI (72% vs. 98%, p < 0.001; 64% vs. 96%, p < 0.001; and 49% vs. 81%, p < 0.001, respectively). Patients with stage 1a AKI had a lower 30-day and 90-day survival compared to the group of patients who did not develop AKI (71% vs. 96%, p < 0.001, and 71% vs. 91%, p < 0.01, respectively) and better survival than patients with more severe AKI (71% vs. 40%, p < 0.01).
AKI was independently associated with mortality in patients with cirrhosis, even at the very early 1a stage. Response to treatment improved survival, and was inversely proportional to the stage of AKI, which suggests that treatment should be started at the earliest stage of AKI.
急性肾损伤（AKI）在肝硬化患者中很常见。2015 年，国际腹水俱乐部（ICA）提出了 AKI 的新定义，以改善预后预测。我们的目的是评估 2015 年 ICA-AKI 标准在住院肝硬化患者中的患病率和预后价值。
我们前瞻性地收集了 2016 年 11 月至 2017 年 11 月期间连续收治的 405 例肝硬化患者的数据。根据 ICA 2015 标准，在纳入时诊断 AKI，并评估其预测 30 天和 90 天院内死亡率的能力。
78 例（19.3%）患者诊断为 AKI。AKI 与 90 天死亡独立相关（HR 7.61；95%CI 4.75-12.19；p<0.001）。与无 AKI 组相比，AKI 组患者住院期间 30 天和 90 天的生存率较低（72% vs. 98%，p<0.001；64% vs. 96%，p<0.001；49% vs. 81%，p<0.001）。1a 期 AKI 患者的 30 天和 90 天生存率低于未发生 AKI 的患者（71% vs. 96%，p<0.001；71% vs. 91%，p<0.01），高于更严重 AKI 患者（71% vs. 40%，p<0.01）。
AKI 与肝硬化患者的死亡率独立相关，即使在非常早期的 1a 期也是如此。对治疗的反应改善了生存率，与 AKI 的阶段呈反比，这表明应在 AKI 的最早阶段开始治疗。
