| Journal: | Acta gastroenterológica latinoamericana |
| Database: | PERIÓDICA |
| System number: | 000315835 |
| ISSN: | 0300-9033 |
| Authors: | Mathurin, Sebastián1 Jaimet, Celia Turletti, Carolina Arosio, Andrea González, Guadalupe Kuzmicz, Gisela |
| Institutions: | 1Hospital I. Carrasco Avellaneda, Rosario, Santa Fe. Argentina |
| Year: | 2008 |
| Season: | Jun |
| Volumen: | 38 |
| Number: | 2 |
| Pages: | 116-125 |
| Country: | Argentina |
| Language: | Español |
| Document type: | Artículo |
| Approach: | Experimental |
| Spanish abstract | Introducción: la insuficiencia renal (IR) es una complicación frecuente en pacientes con cirrosis y ascitis. Objetivo: evaluar la incidencia, etiologías, factores predictivos y pronóstico de la IR en pacientes cirróticos con ascitis. Pacientes y métodos: estudio descriptivo de casos y controles. Se revisaron las historias clínicas de 162 internaciones en 103 pacientes durante 3 años. Se consideró IR cuando hubo un aumento de la creatininemia > 1,5 mg/dl. Se compararon los factores predictores, características clínicas y mortalidad de los pacientes con y sin IR. Resultados: se identificaron 35 casos de IR (21,6%). Mortalidad hospitalaria 18,5%: con IR 57,1%, controles 7,8% (p<0,01). Etiología: falla prerrenal reversible (54,3%), SHR 1 (14,2%) y 2 (5,7%), shock séptico por PBE (11,4%), NTA (8,5%). Los pacientes con y sin IR tuvieron un índice Child-Pügh promedio (± DS): 12.8 (1.8) y 11.4 (1.9) (p=0.0002) respectivamente. Los pacientes con IR tuvieron valores más elevados de bilirrubina, AST, ALT, glóbulos blancos, tiempo de protrombina y menores valores de sodio sérico, Hto, Hb, proteinemia, albuminemia y colinesterasa sérica que los controles (p<0,05). Las variables clínicas asociadas con IR incluyeron las infecciones (OR 1,4), PBE (OR 4) y encefalopatía hepática (OR 2,4). En el análisis multivariado los factores predictivos independientes para IR fueron hiponatremia, bilirrubinemia mayor a 10 mg/dl y PBE. Conclusiones: en pacientes cirróticos internados con ascitis la IR tiene una elevada mortalidad. La principal causa fue la falla prerrenal reversible. El riesgo de IR está significativamente aumentado en pacientes con hiponatremia, hiperbilirrubinemia marcada y PBE |
| English abstract | Background: renal insufficiency (RI) is a frequent complication in patients with cirrhosis and ascites. Objective: to assess the incidence, causes, predictive factors and prognosis of RI in cirrhotic patients with ascites. Patient and methods: descriptive study of cases and controls. Clinical histories of 162 admissions in 103 patients during 3 years were reviewed. It was considered RI when there was an increase of creatininemia > 1,5 mg/dl. The predictive factors, clinical features, and mortality of the patients with and without RI were compared. Results: a diagnosis of RI was made in 35 cases (21.6%). Hospital mortality rate was 18.5%: with RI 57.1%, controls 7.8% (p< 0.01). Etiology: reversible prerrenal failure (54.3%), SHR 1 (14.2%) and 2 (5.7%), septic shock by spontaneous bacterial peritonitis (SBP) (11.4%), NTA (8.5%). The patients with and without RI had a Child-Pügh score average (± DS): 12.8 (1.8) and 11,4 (1.9) (p=0.0002) respectively. The patients with RI had higher values of total bilirubin, AST, ALT, white blood cells, time prothrombin, and minors values of serum sodium, Hto, Hb, protein, albumin and cholinesterase that controls (p<0.05). The clinical variables associated with RI included infections (OR 1.4), SBP (OR 4) and hepatic encephalopathy (OR 2.4). In the multivariate analysis, the independent predictive factors for RI were hyponatremia, bilirubinemia greater to 10 mg/dl and SPB. Conclusion: in cirrhotic patients RI have high mortality. The most frequent cause was reversible prerrenal failure. The risk of RI was increased significantly in patients with hyponatremia, marked hyperbilirubinemia and SPB |
| Disciplines: | Medicina |
| Keyword: | Diagnóstico, Gastroenterología, Nefrología, Cirrosis, Ascitis, Síndrome hepatorrenal, Insuficiencia renal, Pronóstico |
| Keyword: | Medicine, Diagnosis, Gastroenterology, Nephrology, Cirrhosis, Ascites, Hepatorenal syndrome, Renal failure, Prognosis |
| Full text: | Texto completo (Ver PDF) |
