肝硬化患者肾小球滤过率的估计：目前临床实践中使用的方

StephenW

肝硬化患者肾小球滤过率的估计：目前临床实践中使用的方程的评估和皇家自由医院肝硬化肾小球滤过率的验证

Protopapas，阿多尼斯 A.a；帕帕乔瓦尼，约阿纳布； Fragkou, Nikolaosb; Alevroudis, Emmanouilc;西纳科斯，埃马努伊布； Goulis, Ioannisb
作者信息

a 塞萨洛尼基亚里士多德大学 AHEPA 医院内科第一前科

b 塞萨洛尼基亚里士多德大学内科第四系，塞萨洛尼基 Hippokration 医院

c第二放射科，核医学科，雅典国立和卡波迪斯特里安大学，综合大学医院“Attikon”，希腊雅典

2020 年 5 月 28 日接收 2020 年 8 月 17 日接受

致希腊塞萨洛尼基 AHEPA 医院塞萨洛尼基亚里士多德大学内科第一前科 Adonis A. Protopapas，电话：+302313303478；电子邮箱：[email protected]
欧洲胃肠病学和肝病学杂志：2022 年 1 月 - 第 34 卷 - 第 1 期 - 第 84-91 页
doi：10.1097/MEG.0000000000001935

    买

抽象的
客观的

据报道，传统的基于肌酐的肾小球滤过率 (GFR) 方程会高估肝硬化患者的肾功能。皇家自由医院 (RFH) 肝硬化 GFR 方程旨在准确估计该人群的 GFR。本研究的目的是评估广泛使用的方程 [慢性肾脏病流行病学协作方程 (CKD-EPI)、肾脏疾病方程中的饮食修正 (MDRD-4、MDRD-6)] 和 RFH 方程正确的能力估计肝硬化患者的 GFR。
方法

我们回顾性分析了使用 51Cr-EDTA (GFR-M) 测量 GFR 的肝硬化患者的数据。计算了 CKD-EPI、MDRD-4、MDRD-6 和 RFH 方程，同时估计了每一个方程的偏差、精确度和准确度，然后与配对 t 检验进行比较。偏差定义为 GFR-M 与每个方程结果之间的平均差异；精度定义为差异的 SD，准确度定义为均方误差的平方根（均方差的平均值）。较高的值与更差的偏差和更好的精度/准确度相关。
结果

包括一百三十四名肝硬化患者。 CKD-EPI、MDRD-4、MDRD-6 和 RFH 的偏差估计分别为 -5.91、-3.13、0.92 和 18.24。在所有方程之间观察到显着差异（P < 0.001）。关于精度，只有 MDRD-4 (20.81) 和 RFH (16.6) 之间的比较产生了统计学上显着的结果 (P = 0.037)。最后，CKD-EPI (19.32) 和 MDRD-6 (18.81) 表现出比 GFR-RFH (24.61) 更好的准确度（P = 0.006 和 0.001）。
结论

与传统方程相比，RFH 在预测肝硬化患者肾功能方面的准确性较差。
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StephenW

Estimation of glomerular filtration rate in patients with cirrhosis: evaluation of equations currently used in clinical practice and validation of Royal Free Hospital cirrhosis glomerular filtration rate

Protopapas, Adonis A.a; Papagiouvanni, Ioannab; Fragkou, Nikolaosb; Alevroudis, Emmanouilc; Sinakos, Emmanouilb; Goulis, Ioannisb
Author Information

aFirst Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital

bFourth Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki

cSecond Department of Radiology, Nuclear Medicine Unit, National and Kapodistrian University of Athens, General University Hospital ‘Attikon’, Athens, Greece

Received 28 May 2020 Accepted 17 August 2020

Correspondence to Adonis A. Protopapas, First Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece, Tel: +302313303478; e-mail: [email protected]
European Journal of Gastroenterology & Hepatology: January 2022 - Volume 34 - Issue 1 - p 84-91
doi: 10.1097/MEG.0000000000001935

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Abstract
Objective

Conventional creatinine-based glomerular filtration rate (GFR) equations have been reported to overestimate renal function in patients with cirrhosis. The Royal Free Hospital (RFH) cirrhosis GFR equation was developed to accurately estimate GFR in this population. The aim of this study was to evaluate the ability of widely available equations [Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI), Modification of Diet in Renal Disease equations (MDRD-4, MDRD-6)] and the RFH equation to correctly estimate the GFR of patients with cirrhosis.
Methods

We retrospectively analyzed data from patients with cirrhosis who underwent measurement of GFR with the use of 51Cr-EDTA (GFR-M). The CKD-EPI, MDRD-4, MDRD-6 and RFH equations were calculated, while bias, precision and accuracy were estimated for each one of them and then compared with paired t-tests. Bias was defined as the mean difference between the GFR-M and the result of each equation; precision was defined as the SD of the differences and accuracy was defined as the square root of the mean squared error (mean of the squared differences). Higher values are associated with worse bias and better precision/accuracy.
Results

One-hundred and thirty-four cirrhotic patients were included. Bias was estimated for CKD-EPI, MDRD-4, MDRD-6 and RFH at −5.91, −3.13, 0.92 and 18.24, respectively. Significant differences were observed between all equations (P < 0.001). Regarding precision, only the comparison between MDRD-4 (20.81) and RFH (16.6) yielded a statistically significant result (P = 0.037). Finally, CKD-EPI (19.32) and MDRD-6 (18.81) exhibited better accuracy than GFR-RFH (24.61) (P = 0.006 and 0.001).
Conclusion

RFH demonstrates inferior accuracy in predicting renal function in patients with cirrhosis, in comparison to conventional equations.
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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StephenW 发表于 2021-11-30 06:10
Estimation of glomerular filtration rate in patients with cirrhosis: evaluation of equations curren ...

我感觉我就属于这种情况：“ 传统的基于肌酐的肾小球滤过率 (GFR) 方程会高估肝硬化患者的肾功能。”