Jain Shubham, Udgirkar Suhas, Rathi Pravin M, Thanage Ravi, Debnath Prasanta, Junar Parmeshwar, Chandnani Sanjay, Contractor Qais Q
Assistant Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India.
Professor, Department of Gastroenterology, Topiwala National Medical College and BYL Nair Charitable Hospital, Dr. A.L Nair Road, Mumbai- 400 008, Maharashtra, India.
Middle East J Dig Dis. 2023 Apr;15(2):107-115. doi: 10.34172/mejdd.2023.328. Epub 2023 Apr 30.
Acute kidney injury (AKI) occurs in 20-50% of patients with cirrhosis and is associated with a poor prognosis. The aim of the study is to identify the baseline factors affecting mortality in these patients at 30 and 90 days. We enrolled 117 patients with cirrhosis and AKI and followed them up prospectively. Distribution of International club of ascites AKI stages was: 26 (22.03%) stage 1, 59 (50%) stage 2, and 33 (28%) stage 3. Mortalities at 30 and 90 days were 27 (22.8%) and 33 (27.9%) respectively. On multivariate analysis, variables affecting mortality at 30 days were serum creatinine level>2 mg% at 48 hours after AKI development (adjusted OR 7.93, =0.02) and leukocytosis (total leucocyte count>11000/mm ) at admission (adjusted OR 6.54, =0.002). Only leukocytosis at admission was a predictor of 90 days mortality (adjusted OR 4.76, =0.01). Though not statistically significant, patients not responding to standard medical treatment had 3 times higher mortality at 30 days, while the maximum AKI stages (2 and 3) had eight times higher mortality at 90 days. In cirrhosis, AKI increases short-term mortality. High serum creatinine at 48 hours affects mortality at 30 days, while leukocytosis at baseline predicts mortality at 30 and 90 days. Progression to a higher AKI stage impacts prognosis.
急性肾损伤（AKI）发生于20%至50%的肝硬化患者中，且与预后不良相关。本研究的目的是确定影响这些患者30天和90天死亡率的基线因素。我们纳入了117例肝硬化合并AKI患者，并对他们进行前瞻性随访。国际腹水俱乐部AKI分期分布为：1期26例（22.03%），2期59例（50%），3期33例（28%）。30天和90天的死亡率分别为27例（22.8%）和33例（27.9%）。多因素分析显示，影响30天死亡率的变量为AKI发生后48小时血清肌酐水平>2mg%（校正OR 7.93，P=0.02）和入院时白细胞增多（白细胞总数>11000/mm³）（校正OR 6.54，P=0.002）。仅入院时白细胞增多是90天死亡率的预测因素（校正OR 4.76，P=0.01）。虽然无统计学意义，但对标准药物治疗无反应的患者30天死亡率高出3倍，而最大AKI分期（2期和3期）患者90天死亡率高出8倍。在肝硬化中，AKI会增加短期死亡率。48小时时高血清肌酐影响30天死亡率，而基线时白细胞增多可预测30天和90天死亡率。进展至更高AKI分期会影响预后。
