肝硬化急性肾损伤新标准(ICA2015)下治疗应答和预后的回顾性分析及影响因素研究

Therapeutic response and prognosis under the new criteria (ICA2015) of acute kidney injury in cirrhosis patients and influencing factors

目的观察肝硬化急性肾损伤(AKI)新诊断标准和治疗管理流程下(ICA2015)治疗应答和预后的情况,并分析相关的影响因素。方法回顾性分析2016年7月至2017年6月在海军军医大学长海医院感染科住院的220例肝硬化失代偿期患者。收集住院期间的数据,评估疗效及短期预后。通过Logistic回归和ROC曲线分析明确AKI及预后的影响因素。结果共纳入肝硬化(失代偿期)患者220例,住院期间AKI的发生率为27.7%(61/220)。1期AKI患者39例,37例有治疗应答,33例预后良好,2例患者出院后再发AKI;2期AKI患者19例,16例有治疗应答,12例预后良好,2例患者出院后再发AKI;3期AKI患者3例,1例治疗应答(完全应答),但均于住院期间或出院3个月内死亡。并发AKI的影响因素为:MELD评分、基线SCr、是否存在感染;并发AKI的患者预后的影响因素为:TBil、Alb、INR、AKI治疗应答;但肝硬化(失代偿期)患者的整体预后仅与TBil、ALT、并发症的数量相关。结论 ICA更新的肝硬化急性肾损伤诊断和管理流程提升了诊断的敏感度和治疗应答的比例,使以往忽略的部分患者得到了及时的处理,改善了预后,但仍存在较多的问题。

Objective To investigate the treatment response and prognosis of the new diagnostic criteria of cirrhosis with acute kidney injury(AKI)in cirrhosis patients(International Club of Ascites 2015,ICA2015),and to analyze the related factors.Methods There were 220 patients with decompensated liver cirrhosis patients in our hospital from July2016 to June 2017 enrolled in the retrospective study.Clinical data during hospitalization were collected for assessing treatment efficacy and short-term prognosis.Risk factors for AKI and its prognosis were analyzed with logistic regression and receiver operating characteristic(ROC)curve.Results Incidence of concurrent AKI during hospitalization was 27.7% in 220 decompensated liver cirrhosis patients.Thirty-nine patients were in AKI stage 1,among whom 94.9% had therapeutic response,84.6% had good prognosis and 5.1% had AKI recurrence after discharge.Nineteen patients were in AKI stage2,among hom 84.2% had therapeutic response,63.2% had good prognosis and 10.5% had AKI recurrence after discharge.Three patients were in AKI stage 3,among whom1 had complete response,but all died during hospitalization or within 3 months discharge.Factors for concurrent AKI in cirrhosis patients were MELD score,baseline serum creatinine,and infection status.Factors for prognosis of cirrhosis patients with AKI were total bilirubin(TB),albumin,international normalized ratio and AKI treatment response.However,the prognosis in decompensated cirrhosis patients was only related to TB,alanine aminotransferase and number of complications.Conclusion Compared to old ICA guideline,increased diagnostic sensitivity,higher proportion of therapeutic response and prognosis improved from ICA2015 are observed in AKI patients with cirrhosis.Though there are still many problems in ICA2015.