科研之友
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摘要
Background %26 Aims: For several years hepatologists have defined acute renal failure in patients with cirrhosis as an increase in serum creatinine (sCr) %26gt;= 50% to a final value of sCr %26gt; 1.5 mg/dl (conventional criterion). Recently, the Acute Kidney Injury Network (AKIN) defined acute renal failure as acute kidney injury (AKI) on the basis of an absolute increase in sCr of 0.3 mg/dl or a percentage increase in sCr %26gt;= 50% providing also a staging from 1 to 3. AKIN stage 1 was defined as an increase in sCr %26gt;= 0.3 mg/dl or increase in sCr %26gt;= 1.5-fold to 2-fold from baseline. AKI diagnosed with the two different criteria was evaluated for the prediction of in-hospital mortality. %26lt;br%26gt;Methods: Consecutive hospitalized patients with cirrhosis and ascites were included in the study and evaluated for the development of AKI. %26lt;br%26gt;Results: Conventional criterion was found to be more accurate than AKIN criteria in improving the prediction of in-hospital mortality in a model including age and Child-Turcotte-Pugh score. The addition of either progression of AKIN stage or a threshold value for sCr of 1.5 mg/dl further improves the value of AKIN criteria in this model. More in detail, patients with AKIN stage 1 and sCr %26lt; 1.5 mg/dl had a lower mortality rate (p = 0.03), a lower progression rate (p = 0.01), and a higher improvement rate (p = 0.025) than patients with AKIN stage 1 and sCr %26gt;= 1.5 mg/dl. %26lt;br%26gt;Conclusions: Conventional criterion is more accurate than AKIN criteria in the prediction of in-hospital mortality in patients with cirrhosis and ascites. The addition of either the progression of AKIN stage or the cut-off of sCr %26gt;= 1.5 mg/dl to the AKIN criteria improves their prognostic accuracy.
- 出版日期2013-9
