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BMC Surgery

, 16:63

Visceral and general surgery

Abstract

BackgroundProteinuria is a manifestation of renal dysfunction and it has been demonstrated to be a significant prognostic factor in various clinical situations. The study was designed to analyze prognosis of patients receiving liver transplantation as well as to determine predictive performance of perioperative proteinuria.

MethodsWe retrospectively reviewed data of patients who had received a liver transplant in a medical center between 2002 and 2010. Demographic information and clinical characteristic parameters were recorded on the day of intensive care unit admission before operation and on postoperative days 1, 7, and 14.

ResultsAmong a total of 323 patients, in-hospital mortality and 90-day mortality rates were 13.0 % 42-323 and 14.2 % 46-323, respectively. Patients with proteinuria on admission had higher rates of acute kidney injury 26.8 % vs. 8.8 %, p < 0.001, severe infection episodes 48.8 % vs. 30.7 %, p = 0.023, hospital death 31.1 % vs. 10.1 %, p < 0.001, and 90-day mortality 37.7 % vs. 10.9 %, p < 0.001. Multivariate analysis showed that proteinuria on admission and Sequential Organ Failure Assessment SOFA score were independent predictors of in-hospital mortality. The discriminatory ability of proteinuria plus SOFA was even better than that of SOFA alone, especially on postoperative day 1.

ConclusionsThe presence of proteinuria before liver transplantation is supposed to be recognized as a negative predictor for in-hospital survival. Moreover, the presence of proteinuria after liver transplantation can assist in the early prediction of poor short-term prognosis for patients receiving liver transplantation.

KeywordsLiver transplantation Proteinuria SOFA Prognosis Mortality AbbreviationsAKIAcute kidney injury

AUROCArea under the receiver operating characteristic curve

CP pointsChild-pugh points

ICUIntensive care units

MELDModel for end-stage liver disease

OPOperation

RIFLEThe risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage renal failure

SCrSerum creatinine

SOFASequential organ failure assessment

TIPSTransjugular intrahepatic portosystemic shunt

UACRUrine albumin-creatinine ratio

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Fuente: https://link.springer.com/article/10.1186/s12893-016-0176-8







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