Renal failure and cirrhosis: A systematic review of mortality and prognosis

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• 作者：Giuseppe Fede¹ ; ² ; Gennaro D&rsquo ; Amico³ ; Vasiliki Arvaniti¹ ; Emmanuel Tsochatzis¹ ; Giacomo Germani¹ ; Dimosthenis Georgiadis¹ ; Alberto Morabito⁴ ; Andrew Kenneth Burroughs¹ ; ^{andrew.burroughs@nhs.net}
• 关键词：RF ; renal failure ; MELD ; model for end stage liver disease ; HRS ; hepatorenal syndrome ; HCC ; hepatocellular carcinoma ; SBP ; spontaneous bacterial peritonitis ; SCr ; serum creatinine ; OR ; odds ratio ; POR ; pooled odds ratios ; CI ; confidence interval
• 刊名：Journal of Hepatology
• 出版年：2012
• 期刊代码：162_01688278
• 类别：med
• 出版时间：April, 2012
• 卷：56
• 期：4
• 页码：810-818
• 文件大小：877 K

摘要

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Background & Aims

To evaluate renal failure (RF) in cirrhosis to determine and quantify its prognostic significance.

Methods

Studies were identified by MEDLINE, EMBASE, Cochrane, ISI Web of Science (1977-2010); search terms included renal failure, mortality, and cirrhosis. Included studies (n = 74) reported >10 patients and mortality data (8088 patients). Mortality at 1, 3, and 12 months was evaluated with respect to Child-Pugh score, serum creatinine, ascites, ICU status or sepsis, prospective study design, and publication year. Pooled odds ratio (POR) for death was compared for RF vs. non-RF (5668 patients).

Results

Overall median mortality for RF patients was 67%: 58%at 1 month and 63%(IQR 54-79) at 12 months. POR for death RF vs. non-RF patients was 7.6 (95% CI 5.4-10.8). Overall mortality before 2005 (1264 patients) was 74%and after 2005 (2833 patients) was 63%with a marked reduction only at 30 days (71%vs. 52%).

Conclusions

This study provides a measure of the increased risk of death in cirrhosis with renal failure. RF increases mortality 7-fold, with 50%of patients dying within one month. Preventative strategies for RF are needed.