Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
BMC Gastroenterol. 2023 Jun 23;23(1):218. doi: 10.1186/s12876-023-02858-5.
Hepatorenal syndrome (HRS) is a life-threatening complication of end-stage liver disease. This study aimed to clarify the status of HRS in Japan by analyzing the Japanese Diagnosis Procedure Combination database.
Patients hospitalized for cirrhosis and HRS from July 2010 to March 2019 were sampled. They were divided into two groups according to their prognosis upon discharge: the transplant-free survival group and the death or liver transplantation group. The two groups' baseline patient characteristics and treatments were compared.
The mean age of the 1,412 participants was 67.3 years (standard deviation: 12.3 years), and 65.4% were male. The Child-Pugh grades was B and C in 18.8% and 81.2%, respectively. Hepatocellular carcinoma was present in 27.1% of the patients, and the proportion of spontaneous bacterial peritonitis was 2.3%. Albumin, noradrenaline, and dopamine were administered to 57.9%, 8.0%, and 14.9% of the patients, respectively; 7.0% of the patients underwent renal replacement therapy; and 5.0% were admitted to the intensive care unit. Intravenous antibiotics were administered to 30.8% of the patients. A total of 925 patients (65.5%) died or underwent liver transplantation. In addition to a higher proportion of patients with poor baseline liver function, the death or liver transplantation group included more males, patients with hepatocellular carcinoma, and those with spontaneous bacterial peritonitis.
HRS in Japan has a high mortality rate. Albumin was administered to over 50% of participants. Although noradrenaline is recommended in Japanese clinical guidelines, dopamine was more frequently used as a vasoconstrictor in clinical practice.
肝肾综合征（HRS）是终末期肝病的一种危及生命的并发症。本研究旨在通过分析日本诊断程序组合数据库来阐明日本的 HRS 现状。
从 2010 年 7 月至 2019 年 3 月，选取因肝硬化和 HRS 住院的患者。根据出院时的预后将患者分为两组：无移植生存组和死亡或肝移植组。比较两组患者的基线特征和治疗方法。
1412 名参与者的平均年龄为 67.3 岁（标准差：12.3 岁），其中 65.4%为男性。Child-Pugh 分级分别为 B 级和 C 级，占 18.8%和 81.2%。27.1%的患者存在肝细胞癌，2.3%的患者发生自发性细菌性腹膜炎。分别有 57.9%、8.0%和 14.9%的患者给予白蛋白、去甲肾上腺素和多巴胺治疗；7.0%的患者接受肾脏替代治疗；5.0%的患者入住重症监护病房。30.8%的患者给予静脉内抗生素治疗。共有 925 名患者（65.5%）死亡或接受肝移植。死亡或肝移植组除了基线肝功能较差的患者比例较高外，还包括更多的男性、肝细胞癌患者和自发性细菌性腹膜炎患者。
日本的 HRS 死亡率较高。超过 50%的参与者接受了白蛋白治疗。尽管去甲肾上腺素在日本临床指南中被推荐，但在临床实践中多巴胺更常被用作血管收缩剂。
