Mattos Ângelo Z, Dornelles Caroline Machado Rotta, Schiavon Leonardo de Lucca, Mendes Liliana Sampaio Costa, de Carvalho Filho Roberto José, Codes Liana, Farias Alberto Queiroz, Álvares-da-Silva Mário Reis, Terra Carlos, Pereira Gustavo, Manica Muriel, Bischoff Helena Marcon, Narciso-Schiavon Janaína Luz, Romeres Silas Gustavo Barboza, Garcia Jéssica Bastos, Bittencourt Paulo Lisboa, Ximenes Rafael Oliveira, Arrojo Raul Salinas, Mattos Angelo A
Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, 245 Sarmento Leite Street, Porto Alegre, RS, Brazil.
Gastroenterology and Hepatology Unit, Irmandade Santa Casa de Misericórdia de Porto Alegre, 295 Professor Annes Dias Street, Porto Alegre, RS, Brazil.
Hepatol Int. 2025 Feb 27. doi: 10.1007/s12072-025-10790-x.
Acute kidney injury is a severe complication of cirrhosis. However, the impact of mild decreases in renal function is controversial. This study aims to evaluate the prognosis of the different stages of acute kidney injury in cirrhosis.
This is a multicenter prospective cohort study of patients hospitalized for acute decompensation of cirrhosis, with serum creatinine values measured at least twice. Primary outcome was mortality (in-hospital, 30 days, 90 days and 12 months).
Nine hundred twenty-eight patients were included in the study. Acute kidney injury was diagnosed in 505 patients (stages 1a-21.6%, 1b-27.5%, 2-28.1%, 3-22.8%). Mortality rates of patients with acute kidney injury stage 1a were significantly higher than those of individuals without acute kidney injury (in-hospital-19.3% vs 4.7%; 30-day-21.8% vs 6.7%; 90-day-35.2% vs 17.5%; 12-month-54.1% vs 37.1%; p < 0.05 for all comparisons). Mortality rates were even higher for acute kidney injury stages 1b, 2 and 3. Survival analysis demonstrated that patients without acute kidney injury performed significantly better than those with any stage of acute kidney injury (p < 0.01). Acute kidney injury stages 1a, 1b, 2 and 3 were independently associated with survival in the multivariate analysis (p < 0.01).
Patients hospitalized for acute decompensation of cirrhosis who develop acute kidney injury have significantly higher mortality rates than those who do not develop this complication. This is true even for the mildest stages of acute kidney injury (stage 1a) and remains so at different time-points, supporting recommendations for earlier treatments.
急性肾损伤是肝硬化的一种严重并发症。然而，肾功能轻度下降的影响存在争议。本研究旨在评估肝硬化患者急性肾损伤不同阶段的预后。
这是一项针对因肝硬化急性失代偿而住院患者的多中心前瞻性队列研究，血清肌酐值至少测量两次。主要结局指标是死亡率（住院期间、30天、90天和12个月）。
928例患者纳入本研究。505例患者诊断为急性肾损伤（1a期占21.6%，1b期占27.5%，2期占28.1%，3期占22.8%）。急性肾损伤1a期患者的死亡率显著高于无急性肾损伤者（住院期间：19.3%对4.7%；30天：21.8%对6.7%；90天：35.2%对17.5%；12个月：54.1%对37.1%；所有比较p＜0.05）。急性肾损伤1b期、2期和3期患者的死亡率更高。生存分析表明，无急性肾损伤的患者比任何急性肾损伤阶段的患者表现显著更好（p＜0.01）。多因素分析中，急性肾损伤1a期、1b期、2期和3期均与生存独立相关（p＜0.
