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Abdominal Hypoperfusion and Acute Kidney Injury in the Critically Ill Patient with Liver Cirrhosis

2024-06-18Artigo científico Acesso aberto
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dc.contributor.authorPereira, Rui
dc.contributor.authorLopes, Diogo
dc.contributor.authorMachado, Sara Brandão
dc.contributor.authorVal-Flores, Luís
dc.contributor.authorCaeiro, Fernando
dc.contributor.authorPerdigoto, Rui
dc.contributor.authorMarcelino, Paulo Alexandre
dc.contributor.authorSaliba, Faouzi
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblKarger
dc.date.accessioned2024-07-11T22:19:53Z
dc.date.available2024-07-11T22:19:53Z
dc.date.issued2024-06-18
dc.description.abstractBackground: Reduced abdominal perfusion pressure (APP) is an underdiagnosed potential pathophysiological mechanism for acute kidney injury (AKI) in the patient with liver cirrhosis and ascites. This study aimed to analyze the prevalence of abdominal hypoperfusion (AhP) (APP <60 mm Hg) and the impact of APP on AKI in critically ill patients with liver cirrhosis. Methods: This was a post hoc analysis from a prospective cohort study set in a general ICU at a tertiary university hospital. Patients were recruited between October 2016 and December 2021. Acute renal failure (ARF) was defined by stage 3 AKI according to the International Club of Ascites. Results: Fifty-eight patients where included, with a mean age of 57 (±8.4) years, 79% were male, and 93% had acute-on-chronic liver failure at admission. The prevalence of AhP reached 75%, and 29% of cases had persisting AhP during the first week of ICU stay. Patients with baseline AhP had a higher 28-day mortality compared to those without AhP (respectively, 76% vs. 49%, p = 0.03). Acute renal failure developed in 48% of patients. Higher serum urea (aOR: 1.01, 95% CI: 1.00–1.02, p = 0.04) and white blood cell count (aOR: 1.1, 95% CI: 1.01–1.2, p = 0.02) at ICU admission, as well as low persisting APP (aOR: 0.9, 95% CI: 0.86–0.98, p = 0.02) were independent risk factors for ARF. Conclusion: Critically ill patients with liver cirrhosis presented a high prevalence of ARF, independently associated with higher baseline serum urea and WBC, and lower persisting APP. A structured clinical approach to optimize APP may reduce renal dysfunction in high-risk patients with cirrhosis.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent395263
dc.identifier.doi10.1159/000538939
dc.identifier.issn2341-4545
dc.identifier.otherPURE: 94848181
dc.identifier.otherPURE UUID: 22768dc8-04f6-49d6-8690-0e59df4b728b
dc.identifier.otherScopus: 85196730759
dc.identifier.otherPubMed: 39906513
dc.identifier.urihttp://hdl.handle.net/10362/169559
dc.identifier.urlhttps://www.scopus.com/pages/publications/85196730759
dc.language.isoeng
dc.peerreviewedyes
dc.subjectAbdominal compartment syndrome
dc.subjectAcute kidney injury
dc.subjectAcute-on-chronic liver failure
dc.subjectLiver cirrhosis
dc.subjectGastroenterology
dc.titleAbdominal Hypoperfusion and Acute Kidney Injury in the Critically Ill Patient with Liver Cirrhosisen
dc.title.subtitleA Prospective Cohort Studyen
dc.typejournal article
degois.publication.firstPage25
degois.publication.issue1
degois.publication.lastPage36
degois.publication.titleGE Portuguese Journal of Gastroenterology
degois.publication.volume32
dspace.entity.typePublication
rcaap.rightsopenAccess

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