Hepatorenal syndrome: diagnostic accuracy, clinical features, and outcome in a tertiary care center
Notice bibliographique
Résumé
OBJECTIVES: Hepatorenal syndrome (HRS) is a common and life-threatening entity that is associated with advanced liver disease. There are limited data on predisposing or precipitating factors related to the development of this syndrome. The aims of this study were: 1) to determine the accuracy of the diagnosis of HRS in an urban tertiary care center; 2) to compare features of HRS with those of non-HRS renal failure; and 3) to document the precipitating factors for HRS in this setting. METHODS: We conducted a retrospective chart review of 46 patients at the Health Sciences Center in Winnipeg, Manitoba, who were diagnosed with HRS within the last 10 yr. In addition to assessing the accuracy of the diagnosis of HRS (as defined by the International Ascites Club), we also developed a database that included clinical and biochemical features of these patients' liver disease, possible predisposing factors, precipitating events, etiology of cirrhosis, and mortality rates. A cohort of 19 patients with advanced liver disease and renal failure not ascribed to HRS (non-HRS) served as controls. RESULTS: A total of 46 patients were labeled as having HRS during their hospital stay, of whom 27 (59%) fulfilled International Ascites Club criteria. Their mean age was 51.8 +/- 12.1 yr, and 67% were male. Demographic and biochemical findings in the HRS patients were similar to those of the non-HRS patients. Hepatic encephalopathy (p < 0.03) and jaundice (p < 0.01) more commonly preceeded renal failure in the HRS group than in the controls. The most common predisposing factor for HRS was alcohol abuse. Precipitating factors for HRS included infection in 48% patients, GI bleeding in 33%, and over paracentesis in 27%. Drug-induced renal disease was significantly more common in patients with non-HRS renal failure. Contrary to previous reports, nonsteroidal anti-inflammatory drugs were not common precipitating factors of HRS. Alcohol-related liver disease was the most common underlying etiology of liver disease in all patients who developed renal failure but was proportionally higher in the HRS group. Mortality was almost universal in both groups, regardless of the cause of renal failure. CONCLUSIONS: The diagnostic accuracy (or lack thereof) of HRS highlights the importance of ensuring that diagnostic criteria are met in studies describing the natural history and/or the results of therapeutic intervention in HRS. Alcohol abuse is a common predisposing factor for the development of HRS. Infection, GI bleed, and aggressive paracentesis were the most common precipitating factors for HRS.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».