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Proteinuria Can Predict Short-term Prognosis in Critically Ill Cirrhotic Patients

Lin, Li-Yuan MD*; Jenq, Chang-Chyi MD*,†; Liu, Cheng-Sheng MD; Huang, Chun-Sheng MD; Fan, Pei-Chun MD*; Chang, Chih-Hsiang MD*; Lee, Shen-Yang MD*; Chang, Ming-Yang MD, PhD*,†; Tian, Ya-Chung MD, PhD*,†; Hung, Cheng-Chieh MD, PhD*,†; Tsai, Ming-Hung MD†,‡; Fang, Ji-Tseng MD*,†; Yang, Chih-Wei MD*,†; Chen, Yung-Chang MD*,†

Journal of Clinical Gastroenterology: April 2014 - Volume 48 - Issue 4 - p 377–382
doi: 10.1097/MCG.0000000000000060
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Background and Aim: Increasing evidence supports that proteinuria is a useful tool in several clinical situations. Cirrhotic patients with proteinuria admitted to intensive care units (ICUs) have high mortality rates. This study analyzed the outcomes of critically ill cirrhotic patients and determined the prognostic value of proteinuria.

Methods: A total of 230 cirrhotic patients were admitted to the ICU of a hospital in Taiwan between March 2008 and February 2011. We prospectively collected data, including demographic parameters and clinical characteristics, of patients on day 1 of admission to the ICU and analyzed these variables as predictors of mortality.

Results: The overall ICU, hospital, and 90-day mortality rates were 54%, 60%, and 63%, respectively. The patients with proteinuria had higher rates of acute kidney injury (84% vs. 53%, P<0.001), ICU death (60% vs. 25%, P<0.001), and 90-day mortality (79% vs. 40%, P<0.001). Patients with proteinuria had a hazard ratio for 90-day mortality of 2.800 (P<0.001; 95% CI, 1.927-4.069). Multivariate analysis showed that proteinuria and the Sequential Organ Failure Assessment score were predictors of short-term prognosis.

Conclusions: Proteinuria in critically ill cirrhotic patients is associated with increased complications of liver cirrhosis, ICU mortality, and poor short-term prognosis.

*Department of Nephrology, Kidney Research Center

Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei

Chang Gung University College of Medicine, Taoyuan, Taiwan

L-Y.L. and C-C.J. contributed equally.

Supported by the National Science Council of Taiwan (NSC 99-2314-B-182A-009-MY3).

C.S.L. and C.S.H. assisted in data collection.

The authors declare that they have nothing to disclose.

Reprints: Yung-Chang Chen, MD, Department of Nephrology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei 105, Taiwan (e-mail: cyc2356@gmail.com).

Received March 2, 2013

Accepted November 19, 2013

© 2014 by Lippincott Williams & Wilkins