Erschienen in:
01.06.2011 | Clinical Commentary
Difficulties in assessing renal function in patients with cirrhosis: potential impact on patient treatment
verfasst von:
Andrew Davenport
Erschienen in:
Intensive Care Medicine
|
Ausgabe 6/2011
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Excerpt
An acute deterioration in renal function in patients with chronic liver disease is strongly associated with increased mortality [
1,
2]. The traditional Child-Turcotte-Pugh (CTP) staging of chronic liver disease did not include renal function, and this has now generally been replaced by the model for end-stage liver disease (MELD score = 9.6 × log
e(creatinine mg/dl) + 3.8 × log
e (bilirubin mg/dl) + 11.20 × log
e (INR) + 6.4) [
3] to predict short-term mortality for cirrhotic patients awaiting liver transplantation. Hepatorenal syndrome (HRS) also uses creatinine as a major inclusion criterion (>1.5 mg/dl or 133 μmol/l) [
4] and to subclassify patients into HRS type 1, doubling of creatinine levels to >2.5 mg/dl (222 μmol/l) within 2 weeks, and type 2, with slower deterioration in renal function [
5]. Although mortality of cirrhotic patients with HRS type 1 remains high, treatment with terlipressin and daily albumin infusion has improved outcomes [
6]. …
