РОЛЬ ДИСФУНКЦИИ ПОЧЕК В ЛЕТАЛЬНЫХ ИСХОДАХ ПРИ ЦИРРОЗЕ ПЕЧЕНИ

Abstract

Introduction. A significant proportion of patients hospitalized due to decompensation of liver cirrhosis have some kind of renal dysfunction (acute kidney injury, hepatorenal syndrome, chronic kidney disease). However, their effect on mortality in cirrhosis has been little studied. Aim. The aim of the research was to study the role of renal dysfunction in fatal outcomes in cirrhosis. Material and methods. The retrospective cohort study was conducted, which included patients with a confirmed diagnosis of cirrhosis hospitalized in the hepatological department and/or the department of anesthesiology-intensive care of City Clinical Hospital No. 1 of the Ministry of Health of Chuvashia in 2014-2018. The medical histories of patients were retrospectively studied. The conclusions of pathoanatomic autopsies were analyzed in deceased patients. At the same time, demographic indicators, etiological factors of cirrhosis, the degree of compensation on the Child-Pugh scale, complications and causes of deaths were taken into account. The results of instrumental studies, laboratory tests were also considered. Particular attention was paid to the study of the frequency of occurrence of various types of renal dysfunction. Potential risk factors for death of patients were determined using a one-dimensional regression analysis. Results and discussion. During 5 years from 2014 to 2018, 634 patients with cirrhosis decompensation received inpatient treatment with a total number of hospitalizations equal to 1,672. During the first hospitalization, 140 patients died, which is 22.1% of the total number of patients. The average age of the deceased patients was 51.4±13.6 years. Alcoholic liver disease prevailed in the etiological structure of fatal cirrhosis (in 35.7% of cases). Hospital mortality was associated in 74.2% of cases with renal dysfunction. Patients with cirrhosis decompensation died most often (26.4 %) from prerenal acute kidney injury. The fatal outcome in cirrhosis was more dependent on indicators characterizing the functional state of the kidneys (serum levels of urea, creatinine, glomerular filtration rate), the hemostasis system (prothrombin index), and to a lesser extent on indicators characterizing the functional state of the liver. Conclusion. Fatal outcomes in cirrhosis were associated in 74.2% of cases to some extent with renal dysfunction.