Acute kidney injury is an unfavorable prognostic factor in acute liver failure and is associated with tumor necrosis factor-alpha

被引：2

作者：

Imoto, Koji ^{[1
]}

Tanaka, Masatake ^{[1
]}

Goya, Takeshi ^{[1
]}

Azuma, Yuki ^{[1
]}

Hioki, Tomonobu ^{[1
]}

Aoyagi, Tomomi ^{[1
]}

Takahashi, Motoi ^{[1
]}

Kurokawa, Miho ^{[1
]}

Kato, Masaki ^{[1
,2
]}

Kohjima, Motoyuki ^{[1
]}

Ogawa, Yoshihiro ^{[1
]}

机构：

[1] Kyushu Univ, Grad Sch Med Sci, Dept Med & Bioregulatory Sci, 3-1-1 Maidashi, Higashi Ku, Fukuoka 8128582, Japan

[2] Nakamura Gakuen Univ, Grad Sch Nutr Sci, Jonan Ku, Fukuoka, Japan

来源：

MEDICINE | 2023年 / 102卷 / 45期

关键词：

acute liver failure; acute liver failure without hepatic coma; acute kidney injury; tumor necrosis factor-alpha; prognosis; INFLAMMATORY RESPONSE SYNDROME; RENAL DYSFUNCTION; HEPATORENAL-SYNDROME; PLASMA-EXCHANGE; CYTOKINES; OUTCOMES; THERAPY;

D O I：

10.1097/MD.0000000000035931

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Acute kidney injury (AKI) is a common complication of acute liver failure (ALF); but its pathogenesis is unknown. ALF was divided into 2 subgroups; ALF with hepatic coma, which corresponds to ALF in the US and Europe, and ALF without hepatic coma. AKI has been shown to worsen the prognosis of ALF patients with hepatic coma; however, its prognostic significance in ALF without hepatic coma remains unknown. A single-center retrospective study of 174 patients with ALF was performed. AKI was defined according to KDIGO criteria. AKI developed in 29 (66.0%) of 44 ALF patients with hepatic coma and 27 (38.5%) of 130 ALF patients without hepatic coma. Systemic inflammatory response syndrome (SIRS) was found to be significantly associated with AKI incidence in ALF patients (P < .001). Tumor necrosis factor-alpha (TNF-alpha) was found to be significantly associated with the presence and severity of AKI (P = .0039 and P = .0140, respectively). On multivariate analysis, TNF-alpha was an independent risk factor linked with AKI (P = .0103). Even in the absence of hepatic coma, the transplant-free survival rate of ALF was significantly associated with the presence and severity of AKI. Even when hepatic coma is absent, AKI complicated in ALF is strongly associated with TNF-alpha and worsens the transplant-free survival rate. Before the onset of hepatic coma, plasma exchange, or extracorporeal blood purification to remove inflammatory cytokines should be considered in ALF patients.

引用

页数：6