背景:急性肾损伤(AKI)常见于终末期肝病和肝硬化患者,并与短期死亡率增加相关。本研究旨在研究肝硬化患者AKI发生和死亡相关的患病率和危险因素。
方法:在当前的前瞻性研究中,纳入2021年10月至2023年3月的肝硬化住院患者.人口统计,临床,收集了实验室数据,其中包括,肝硬化的病因,合并症,肝脏疾病的严重程度,和相关的生化参数。对患者进行90天的随访以记录临床结果。采用SPSS统计软件进行分析。
结果:在364名肝硬化患者中,25.2%(n,92)患有AKI,平均年龄为51.54±11.82岁。研究中的大多数个体是男性(90.4%),酒精(63.4%)是肝硬化最常见的病因。本研究表明,更高水平的直接胆红素(p=0.011)和MELD评分(p=0.0001)被确定为肝硬化患者AKI发展的重要危险因素。关于死亡率,显著的危险因素是AKI(p=0.045)和MELD评分(p=0.025).在AKI患者中,急性肾小管坏死(p值=0.010)和3期AKI(p值=0.001)患者的90天死亡率较高。
结论:AKI常见于肝硬化患者。直接胆红素水平和MELD评分升高是与AKI发展相关的重要因素。此外,AKI和MELD评分被确定为30天和90天死亡的独立危险因素。生存率受AKI类型和分期的影响;AKI3期和ATN患者的死亡率明显较高。早期AKI检测和管理对于降低肝硬化患者的死亡风险至关重要。
BACKGROUND: Acute kidney injury (AKI) occurs frequently in patients with end-stage liver disease and cirrhosis and is associated with increased short-term mortality. This study aims to study the prevalence and risk factors associated with AKI development and mortality in cirrhosis of liver patients.
METHODS: In the current prospective study, hospitalized patients with liver cirrhosis from October 2021 to March 2023 were recruited. Demographic, clinical, and laboratory data were collected, which included, the etiology of cirrhosis, comorbidities, severity of liver disease, and relevant biochemical parameters. The patient was followed up for 90 days to record the clinical outcome. The statistical software SPSS was utilized to conduct the analysis.
RESULTS: Of 364 liver cirrhosis patients, 25.2% (n, 92) had AKI and belonged to an average age of 51.54 ± 11.82 years. The majority of individuals in the study were males (90.4%), and alcohol (63.4%) was the most common etiology of liver cirrhosis. The present study showed that higher level of direct bilirubin (p = 0.011) and MELD score (p = 0.0001) were identified as significant risk factors for AKI development in patients with liver cirrhosis. Regarding mortality, the significant risk factors were the presence of AKI (p = 0.045) and MELD score (p = 0.025). Among AKI patients, 90-day mortality rates were higher in patients with acute tubular necrosis (p value = 0.010) and stage 3 AKI (p value = 0.001).
CONCLUSIONS: AKI is common in cirrhosis of liver patients. Elevated levels of direct bilirubin and MELD score emerged as significant factors associated with AKI development. Furthermore, AKI and MELD scores were identified as independent risk factors for mortality at both 30 and 90 days. Survival rates were influenced by both the type and stage of AKI; AKI stage 3 and ATN patients had significantly higher mortality rate. Early AKI detection and management are crucial for reducing mortality risk in liver cirrhosis patients.