目的:在一个共识会议上,与会者提出定义肝硬化相关急性肾损伤(AKI)基于血清肌酐水平在<6个月内从稳定基线值增加>50%或在<48小时内增加≥0.3mg/dL。我们进行了一项前瞻性研究,以评估这些标准预测肝硬化和感染患者住院后30天内死亡率的能力。
方法:我们随访了337例肝硬化患者,这些患者因感染入院或住院期间发生感染(56%为男性;56±10岁;终末期肝病模型[MELD]评分,20±8)在北美的12个中心。我们比较了30天死亡率的数据,住院时间,有和没有AKI的患者之间的器官衰竭。
结果:总计,基于共识标准,166例患者(49%)在住院期间发生AKI。发生AKI的患者入院时Child-Pugh评分高于未发生AKI的患者(11.0±2.1vs9.6±2.1;P<.0001),MELD评分更高(23±8vs17±7;P<.0001),平均动脉压更低(81±16vs85±15mmHg;P<.01)。AKI患者在住院后30天内死亡的百分比更高(34%vs7%),被转移到重症监护病房(46%对20%),所需通风(27%对6%),或休克(31%vs8%);AKI患者的住院时间也更长(17.8±19.8vs13.3±31.8天)(均P<.001)。在AKI事件中,56%是短暂的,28%是持续性的,16%导致透析。与部分(40%)或完全恢复(15%)或未发生AKI的患者(7%;P<0.0001)相比,无肾脏恢复的患者的死亡率更高(80%)。
结论:在肝硬化患者中,不可逆AKI患者的30天死亡率比无AKI患者高10倍。AKI的共识定义准确地预测了30天的死亡率,住院时间,器官衰竭。
OBJECTIVE: Participants at a
consensus conference proposed defining cirrhosis-associated acute kidney injury (AKI) based on a >50% increase in serum creatinine level from the stable baseline value in <6 months or an increase of ≥ 0.3 mg/dL in <48 hours. We performed a prospective study to evaluate the ability of these criteria to predict mortality within 30 days of hospitalization among patients with cirrhosis and infection.
METHODS: We followed up 337 patients with cirrhosis who were admitted to the hospital with an infection or developed an infection during hospitalization (56% men; 56 ± 10 years of age; Model for End-Stage Liver Disease [MELD] score, 20 ± 8) at 12 centers in North America. We compared data on 30-day mortality, length of stay in the hospital, and organ failure between patients with and without AKI.
RESULTS: In total, based on the
consensus criteria, 166 patients (49%) developed AKI during hospitalization. Patients who developed AKI were admitted with higher Child-Pugh scores than those who did not develop AKI (11.0 ± 2.1 vs 9.6 ± 2.1; P < .0001) as well as higher MELD scores (23 ± 8 vs 17 ± 7; P < .0001) and lower mean arterial pressure (81 ± 16 vs 85 ± 15 mm Hg; P < .01). Higher percentages of patients with AKI died within 30 days of hospitalization (34% vs 7%), were transferred to the intensive care unit (46% vs 20%), required ventilation (27% vs 6%), or went into shock (31% vs 8%); patients with AKI also had longer stays in the hospital (17.8 ± 19.8 vs 13.3 ± 31.8 days) (all P < .001). Of the AKI episodes, 56% were transient, 28% were persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%) compared with partial (40%) or complete recovery (15%) or those who did not develop AKI (7%; P < .0001).
CONCLUSIONS: Among patients with cirrhosis, 30-day mortality is 10-fold higher among those with irreversible AKI than those without AKI. The
consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure.