Outcomes of renal dysfunction in patients with acute liver failure.

Autor: Hadem J; Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.; Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany., Kielstein JT; Department of Nephrology and Hypertensiology, Hannover Medical School, Hannover, Germany.; Department of Nephrology and Hypertensiology, Klinikum Braunschweig, Braunschweig, Germany., Manns MP; Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany., Kümpers P; Division of General Internal Medicine, Nephrology, and Rheumatology, Department of Medicine D, University Hospital Münster, Münster, Germany., Lukasz A; Division of General Internal Medicine, Nephrology, and Rheumatology, Department of Medicine D, University Hospital Münster, Münster, Germany.
Jazyk: angličtina
Zdroj: United European gastroenterology journal [United European Gastroenterol J] 2019 Apr; Vol. 7 (3), pp. 388-396. Date of Electronic Publication: 2018 Dec 03.
DOI: 10.1177/2050640618817061
Abstrakt: Background: Although acute kidney injury (AKI) often accompanies acute liver failure (ALF), its impact on long-term outcome is unknown.
Objective: This study examines the incidence, severity and outcomes of AKI in patients with ALF.
Methods: A total of 134 ALF patients treated at Hannover Medical School between 1995 and 2013 were retrospectively analyzed.
Results: Fifty-four ALF patients (40.3%) demonstrated AKI, as defined by the acute kidney injury network (AKIN) classification, on intensive care unit (ICU) admission, and 85 patients (63.4%) developed AKI prior to ALF recovery, emergency liver transplantation (ELT) or death. AKI severity was closely associated with other end-organ damage ( p  < 0.001). Follow-up creatinine levels in survivors were increased compared to baseline levels (76 versus 64 µmol/l, p  = 0.003). One-hundred-and-three (76.9%) patients reached the combined endpoint of ELT or death, and 42 (31.3%) patients died within 28 days. AKIN stage 3 at ICU admission was the strongest independent predictor of 28-day overall mortality (hazard ratio 3.48, 95% confidence interval 1.75-6.93, p  < 0.001) and ELT or death (hazard ratio 2.52, 95% confidence interval 1.60-3.96, p  < 0.001).
Conclusions: AKI is a frequent complication in ALF that correlates with remote organ damage and long-term creatinine levels and independently predicts outcome.
Databáze: MEDLINE
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