Loeffler Jeffrey, Hassan Mohammed, Qaqish Faris, Dimachkie Reem, Dehghani Shabnam, Sasso Roula, Abou Yassine Ahmad, Deeb Liliane
Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA.
Department of Gastroenterology and Hepatology, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA.
Dig Dis Sci. 2025 Apr;70(4):1540-1546. doi: 10.1007/s10620-025-08881-8. Epub 2025 Feb 15.
Renal failure is a well-known and often devastating complication in patients with liver cirrhosis and contributes to significant morbidity and mortality.
This study aimed to evaluate the clinical profile and factors associated with the utilization of renal replacement therapy (RRT) requirement in cirrhotic patients presenting with AKI.
We conducted a retrospective cohort study of cirrhotic inpatient visits across all Northwell Health hospitals between January 1, 2019 and December 31, 2020. Patients meeting inclusion criteria were identified using the International Classification of Disease, tenth revision clinical modification (ICD-10-CM) codes. Clinical variables, including demographics, medical history, laboratory data, and outcomes, were collected. Statistical analyses were performed to compare variables between patients requiring RRT and those not requiring RRT.
Of 701 cirrhotic patient encounters, 516 met inclusion criteria. The most common etiology of AKI was pre-renal (45.3%), followed by hepatorenal syndrome (18.6%) and acute tubular necrosis (14.7%). Sixty patients (11.6%) required RRT, with worse outcomes observed in this group. Independent predictors of RRT requirement included hepatorenal syndrome, acute tubular necrosis, and pneumonia. Pre-renal AKI was associated with decreased likelihood of requiring RRT.
This study identified clinical and laboratory factors predicting RRT requirement in cirrhotic patients with AKI. Hepatorenal syndrome, acute tubular necrosis, and pneumonia were associated with increased likelihood of RRT. Understanding these predictors may aid in prognostication and management decisions for cirrhotic patients presenting with AKI, warranting further prospective validation studies.
肾衰竭是肝硬化患者中一种广为人知且往往具有毁灭性的并发症，会导致显著的发病率和死亡率。
本研究旨在评估急性肾损伤（AKI）的肝硬化患者接受肾脏替代治疗（RRT）的临床特征及相关因素。
我们对2019年1月1日至2020年12月31日期间在诺斯韦尔健康系统所有医院住院的肝硬化患者进行了一项回顾性队列研究。使用国际疾病分类第十次修订临床修订版（ICD - 10 - CM）编码识别符合纳入标准的患者。收集了包括人口统计学、病史、实验室数据和结局等临床变量。进行统计分析以比较需要RRT的患者和不需要RRT的患者之间的变量。
在701例肝硬化患者就诊病例中，516例符合纳入标准。AKI最常见的病因是肾前性（45.3%），其次是肝肾综合征（18.6%）和急性肾小管坏死（14.7%）。60例患者（11.6%）需要RRT，该组观察到的结局较差。RRT需求的独立预测因素包括肝肾综合征、急性肾小管坏死和肺炎。肾前性AKI与需要RRT的可能性降低相关。
本研究确定了预测AKI肝硬化患者RRT需求的临床和实验室因素。肝肾综合征、急性肾小管坏死和肺炎与RRT可能性增加相关。了解这些预测因素可能有助于对AKI肝硬化患者进行预后评估和管理决策，需要进一步的前瞻性验证研究。
