Diagnosis, treatment and survival of patients with hepatorenal syndrome: A survey on daily medical practice

被引：83

作者：

Salerno, Francesco ^{[1
]}

Cazzaniga, Massimo ^{[1
]}

Merli, Manuela ^{[2
]}

Spinzi, Giancarlo ^{[3
]}

Saibeni, Simone ^{[4
]}

Salmi, Andrea ^{[5
]}

Fagiuoli, Stefano ^{[6
]}

Spadaccini, Antonio ^{[7
]}

Trotta, Elisa ^{[8
]}

Laffi, Giacomo ^{[9
]}

Koch, Maurizio ^{[10
]}

Riggio, Oliviero ^{[2
]}

Boccia, Sergio ^{[11
]}

Felder, Martina ^{[12
]}

Balzani, Simona ^{[13
]}

Bruno, Savino ^{[4
]}

Angeli, Paolo ^{[8
]}

机构：

[1] Univ Milan, Policlin IRCCS San Donato, I-20097 San Donato Milanese, Italy

[2] Univ Roma La Sapienza, Unita Gastroenterol, Rome, Italy

[3] Osped Valduce, Unita Gastroenterol, Como, Italy

[4] Azienda Osped Fatebenefratelli & Oftalm, Unita Med Interna & Epatol, Milan, Italy

[5] Osped St Orsola, Fdn Poliambulanza, Unita Gastroeneterol, Brescia, Italy

[6] Osped Riuniti Bergamo, Unita Strutturale Complessa Gastroenterol, Bergamo, Italy

[7] Osped San Pio Pietrelcina, Unita Gastroenterol, Vasto, Italy

[8] Univ Padua, I-35100 Padua, Italy

[9] Univ Florence, I-50121 Florence, Italy

[10] Azienda Osped San Filippo Neri, Unita Gastroenterol & Epatol, Rome, Italy

[11] Arcispedale St Anna, Unita Gastroenterol & Endoscopia Digest, Ferrara, Italy

[12] Osped Bolzano, Div Gastroenterol, Bolzano, Italy

[13] Osped Santa Maria delle Croci, Unita Operat Gastroenterol & Nutr Clin, Ravenna, Italy

来源：

JOURNAL OF HEPATOLOGY | 2011年 / 55卷 / 06期

关键词：

Ascites; Kidney; Midodrine; Portal hypertension; Terlipressin; SYSTEMIC INFLAMMATORY RESPONSE; RENAL-FAILURE; TERLIPRESSIN THERAPY; REFRACTORY ASCITES; CIRRHOTIC-PATIENTS; ALBUMIN; GLOMERULONEPHRITIS; OCTREOTIDE; HEPATITIS; DISEASE;

D O I：

10.1016/j.jhep.2011.03.012

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：

Background & Aims: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with ascites. The International Ascites Club recommended strict diagnostic criteria and treatment with vasoconstrictors and albumin. Aim of this prospective cohort study was to investigate the prevalence of HRS, diagnostic criteria, treatment and 3-month outcome in the daily-clinical-practice. Methods: Two-hundred-fifty-three patients with cirrhosis and renal failure consecutively admitted to 21 Italian hospitals were recruited. Results: The prevalence of HRS was 45.8% (30% type-1 and 15.8% type-2). In 36% of cases HRS was presumed because not all diagnostic criteria could be fulfilled. In 8% of cases HRS was superimposed on an organic nephropathy. Patients with HRS type-1 were younger and showed higher leukocyte count, higher respiratory rates, and worse liver function scores. Sixty-four patients with HRS type-1 received vasoconstrictors (40 terlipressin and 24 midodrine/octreotide). A complete response was obtained in 19 cases (30%) and a partial response in 13 (20%). Age was the only independent predictor of response (p = 0.033). Three-month survival of patients with HRS type-1 was 19.7%. Survival was better in patients who responded to therapy. Age (p = 0.017), bilirubin (p = 0.012), and creatinine increase after diagnostic volume expansion (p = 0.02) independently predicted death. The mortality rate was 97% among patients with at least two negative predictors. Conclusions: The diagnostic criteria of HRS in our daily-clinical-practice could not be completely fulfilled in one third of cases. The treatment with vasoconstrictors and albumin was widely implemented. Mortality was strongly predicted by simple baseline variables. (C) 2011 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.

引用

页码：1241 / 1248

页数：8

共 26 条

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