간경변 환자의 예후와 연관있는 신기능 지표

Abstract

Background/Aims - Renal dysfunction commonly develops in patients with established liver disease. The assessment of renal function is of clinical importance in patients with cirrhosis and ascites. Renal function indices such as glomerular filtration rate and the plasma renin activity (PRA) could be better predictors of survival than the parameters usually used to estimate liver function including Child - Pugh score. This study was designed to find whether renal function indices are useful in determining the prognosis concerned with the survival of patients with liver cirrhosis. Methods - A total of 110 patients was selected and followed for 89 weeks. As indices reflecting renal function, creatinine clearance rate, PRA, aldosterone concentration, and the pulsatility index (PI) and resistive index (RI) by Doppler ultrasonography were measured. The prognostic values of these indices were determined by comparison and analysis according to survival or death of the patients. For the statistics, univariate and multivariate analysis was done. Results - Child - Pugh score (≥10), creatinine clearance rate (<80 Ml/min), plasma alodosterone concentration (≥15 ng/Dl), PRA ( ≥8 ng/Ml/hr), renal PI ( ≥1.15) and RI (≥0.7) were prognostic indicators in univariate analysis (p<0.05). Multivariate analysis disclosed two independent survival predictors of creatinine clearance rate ( < 80 Ml/min) (OR:5.37, 95% CI: 2.09-13.8) and plasma aldosterone concentration (≥15 ng/Dl) (OR: 3.65, 95% CI: 1.09-12.18). Conclusion - Various renal function indices are closely related to the survival of patients with liver cirrhosis. Creatinine clearance rate and plasma aldosterone concentration are especially important prognostic factors in predicting the survival of patients with liver cirrhosis.