Acute renal failure in cirrhotic patients with severe sepsis: Value of urinary interleukin-18

作者：Tsai Ming Hung; Chen Yung Chang; Yang Chih Wei; Jenq Chang Chi; Fang Ji Tseng; Lien Jau Min; Hung Cheng Chieh; Weng Hsu Huei; Wu Cheng Shyong; Peng Yun Shing; Shen Chien Heng; Tung Shui Yi; Tian Ya Chung^*

来源：Journal of Gastroenterology and Hepatology, 2013, 28(1): 135-141.

DOI：10.1111/j.1440-1746.2012.07288.x

• acute renal failure
• interleukin-18
• liver cirrhosis
• severe sepsis

Background and Aim: Acute renal failure (ARF) is a common complication of liver cirrhosis and severe sepsis. Differentiating functional renal failure from acute tubular necrosis (ATN) has been difficult in this clinical setting. It has been shown that urinary interleukin 18 (IL-18) can serve as a sensitive marker for ARF and ATN. This study was aimed to investigate the diagnostic and prognostic values of urinary IL-18 in ARF associated with liver cirrhosis and severe sepsis. %26lt;br%26gt;Methods: We prospectively evaluated the relationship between urinary IL-18 and clinical outcomes in 168 consecutive cirrhotic patients with severe sepsis. %26lt;br%26gt;Results: One hundred and eight patients (64.3%) developed ARF at admission to the intensive care unit. ARF was associated with higher urinary IL-18 and impaired effective arterial volume. Renal failure was functional in 64 (59.2%), due to acute tubular necrosis (ATN) in 30 (27.7%), and mixed type in 14 (12.9%). Patients with ATN had significantly higher levels of urinary IL-18, rates of vasopressor dependency, and hospital mortality than those with functional renal failure. By using the areas under receiver operating characteristic (AUROC) curve, urinary IL-18 demonstrated an excellent discriminative power (AUROC 0.882) for diagnosing tubular injury in those with ARF. Meanwhile, hospital survivors had significantly lower urinary and serum IL-18 levels, compared to non-survivors. In multivariate analysis, urinary IL-18, international normalized ratio, and mean arterial pressure were independent factors to predict hospital mortality. %26lt;br%26gt;Conclusions: Urinary IL-18 can serve as a diagnostic and prognostic marker in cirrhotic patients with severe sepsis.

• 出版日期2013-1
• 单位长春大学