急性肝衰竭并发急性肾损伤的危险因素及对近期预后的影响

摘要

Objective To investigate the risk factors and short-term outcomes of acute kidney injury (AKI) in patients with acute liver failure (ALF).Methods Total of 167 patients with acute liver failure from January 2008 to June 2015 in our hospital were enrolled. Patients were classiifed by the International Club of Ascites (ICA) revised criteria. The incidence of AKI and short term prognosis were observed.Results Total of 66 cases were complicated with AKI (39.52%), and the proportion of prerenal AKI (PRA), hepatorenal syndrome (HRS) type of AKI (HRS-AKI) and structural kidney injury (intrinsic AKI) were 22.73%, 53.03% and 24.24%, respectively. Out of 66 patients with AKI, 53 cases (80.30%) were dead in-hospital or inefifcacy and 13 cases (19.70%) recovered or improved, which were 31 cases (30.69%) and 70 cases (69.31%) among patients without AKI, respectively, with statistically signiifcant difference (χ2 = 37.338,P< 0.001). Logistic analysis showed that age, infections, TBil and BLA were the independent risk factors for the development of AKI (OR = 1.054, 4.255, 3.599, 3.540, 5.454,P< 0.05).Conclusion AKI affects short-term outcomes, and age, infections, TBil and BLA were the independent risk factors for the development of AKI.%目的：研究急性肝衰竭（ALF）患者并发急性肾损伤（AKI）的危险因素及对近期预后的影响。方法应用新的国际腹水俱乐部（ICA）诊断标准，回顾性分析2008年1月至2015年6月于解放军第302医院住院的ALF患者并发AKI的发生率及近期预后。结果167例ALF患者中并发AKI 66例，发生率为39.52%。其中肾实质性AKI 16例，占24.24%；肾前性AKI 15例，占22.73%；肝肾综合征（HRS-AKI）35例，占53.03%。66例AKI患者院内病死及无效53例（80.30%），恢复与好转13例（19.70%）；非AKI患者101例，院内病死及无效31例（30.69%），恢复与好转70例（69.31%），差异有统计学意义（χ2=37.338，P＜0.001）。Logistic回归分析结果显示，年龄、感染、TBil以及血氨升高是AKI的独立危险因素（OR值分别为1.054、4.255、3.599、3.540、5.454，P均＜0.05）。结论 AKI是影响ALF近期预后的重要因素，年龄、感染、TBil以及血氨升高是AKI发生的独立危险因素。