Incidence and mortality of renal dysfunction in cirrhotic patients with acute gastrointestinal bleeding: a systematic review and meta-analysis

Background: Gastrointestinal bleeding (GIB) is a common complication in cirrhosis. Renal dysfunction may be crucial for the outcomes of cirrhotic patients with acute GIB. This study aimed to explore the incidence and mortality of renal dysfunction in cirrhotic patients with acute GIB.
Methods: The PubMed, EMBASE, and Cochrane Library databases were searched. We pooled the incidence and mortality of renal dysfunction in cirrhotic patients using a random-effect model. Odds ratio (OR) with 95% confidence interval (CI) were calculated.
Results: Seventeen studies were included. The pooled incidence of renal dysfunction was 21% (95%CI = 16%-25%) in cirrhosis with acute GIB. In subgroup analyses, the pooled incidence of renal failure, acute kidney injury (AKI), and renal impairment were 21%, 25%, and 15%, respectively. The pooled mortality was 46% (95%CI = 37%-55%) in cirrhosis with acute GIB and renal dysfunction. In subgroup analyses, the pooled mortality in patients with renal failure, AKI, and renal impairment were 42%, 47%, and 49%, respectively. Renal dysfunction significantly increased the mortality of cirrhosis with acute GIB (OR = 4.92; 95%CI = 3.47–6.96; P < 0.001).
Conclusion: Renal dysfunction is a common indicator for poor outcome of cirrhosis with acute GIB. Prevention of renal dysfunction in such patients should be further explored.

背景：胃肠道出血（Gastrointestinal bleeding, GIB）是肝硬化的常见并发症。肾功能不全对于急性GIB肝硬化患者的预后可能具有关键影响。本研究旨在探讨急性GIB肝硬化患者肾功能不全的发生率与死亡率。方法：检索PubMed、EMBASE及Cochrane Library数据库。采用随机效应模型合并分析肝硬化患者肾功能不全的发生率与死亡率，计算比值比（Odds ratio, OR）及95%置信区间（Confidence interval, CI）。结果：共纳入17项研究。急性GIB肝硬化患者的肾功能不全合并发生率为21%（95%CI=16%~25%）。亚组分析显示，肾衰竭、急性肾损伤（Acute Kidney Injury, AKI）及肾功能减退的合并发生率分别为21%、25%及15%。合并肾功能不全的急性GIB肝硬化患者的合并死亡率为46%（95%CI=37%~55%）；亚组分析显示，肾衰竭、AKI及肾功能减退患者的合并死亡率分别为42%、47%及49%。肾功能不全可显著升高急性GIB肝硬化患者的死亡率（OR=4.92；95%CI=3.47~6.96；P<0.001）。结论：肾功能不全是急性GIB肝硬化患者预后不良的常见预示指标。此类患者的肾功能不全预防策略仍有待进一步探索。