Type-1 Hepatorenal Syndrome Associated With Infections in Cirrhosis: Natural History, Outcome of Kidney Function, and Survival

被引：75

作者：

Barreto, Rogelio ^{[1
,2
,3
,4
]}

Fagundes, Claudia ^{[1
,2
,3
,4
]}

Guevara, Monica ^{[1
,2
,3
,4
]}

Sola, Elsa ^{[1
,2
,3
,4
]}

Pereira, Gustavo ^{[1
,2
,3
,4
]}

Rodriguez, Ezequiel ^{[1
,2
,3
,4
]}

Graupera, Isabel ^{[1
,2
,3
,4
]}

Martin-Llahi, Marta ^{[1
,2
,3
,4
]}

Ariza, Xavier ^{[1
,2
,3
,4
]}

Cardenas, Andres ^{[2
,3
,4
,5
]}

Fernandez, Javier ^{[1
,2
,3
]}

Rodes, Juan ^{[2
]}

Arroyo, Vicente ^{[1
,2
,3
]}

Gines, Pere ^{[1
,2
,3
,4
]}

机构：

[1] Univ Barcelona, Hosp Clin, Liver Unit, Barcelona, Catalunya, Spain

[2] Inst Invest Biomed August Pi Sunyer IDI BAPS, Barcelona, Spain

[3] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Barcelona, Spain

[4] Inst Reina Sofia Invest Nefrol, Barcelona, Spain

[5] Hosp Clin Barcelona, Gastroenterol Unit, E-08036 Barcelona, Spain

来源：

HEPATOLOGY | 2014年 / 59卷 / 04期

关键词：

SPONTANEOUS BACTERIAL PERITONITIS; TERLIPRESSIN PLUS ALBUMIN; RENAL-FAILURE; SERUM CREATININE; MANAGEMENT; PREDICTORS; DIAGNOSIS; THERAPY;

D O I：

10.1002/hep.26687

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

Type-1 hepatorenal syndrome (HRS) is a common complication of bacterial infections in cirrhosis, but its natural history remains undefined. To assess the outcome of kidney function and survival of patients with type-1 HRS associated with infections, 70 patients diagnosed during a 6-year period were evaluated prospectively. Main outcomes were no reversibility of type-1 HRS during treatment of the infection and 3-month survival. Forty-seven (67%) of the 70 patients had no reversibility of type-1 HRS during treatment of the infection. [Correction to previous sentence added March 10, 2014, after first online publication: "Twenty-three (33%)" was changed to "Forty-;seven (67%)."] The main predictive factor of no reversibility of type-1 HRS was absence of infection resolution (no reversibility: 96% versus 48% in patients without and with resolution of the infection; P < 0.001). Independent predictive factors of no reversibility of type-1 HRS were age, high baseline serum bilirubin, nosocomial infection, and reduction in serum creatinine <0.3 mg/dL at day 3 of antibiotic treatment. No reversibility was also associated with severity of circulatory dysfunction, as indicated by more marked activity of the vasoconstrictor systems. In the whole series, 3-month probability of survival was only 21%. Factors associated with poor prognosis were baseline serum bilirubin, no reversibility of type-1 HRS, lack of resolution of the infection, and development of septic shock after diagnosis of type-1 HRS. Conclusion: Type-1 HRS associated with infections is not reversible in two-thirds of patients with treatment of infection only. No reversibility of type-1 HRS is associated with lack of resolution of the infection, age, high bilirubin, and no early improvement of kidney function and implies a poor prognosis. These results may help advance the management of patients with type-1 HRS associated with infections. (Hepatology 2014;59:1505-1513)

引用

页码：1505 / 1513

页数：9

共 27 条

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Hepatorenal syndrome, MELD score and liver transplantation: An evolving issue with relevant implications for clinical practice [J].