<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0186-4866</journal-id>
<journal-title><![CDATA[Medicina interna de México]]></journal-title>
<abbrev-journal-title><![CDATA[Med. interna Méx.]]></abbrev-journal-title>
<issn>0186-4866</issn>
<publisher>
<publisher-name><![CDATA[Edición y Farmacia S.A. de C.V.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0186-48662017000100041</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Asociación de insuficiencia renal aguda con mortalidad y complicaciones en pacientes hospitalizados con cirrosis hepática]]></article-title>
<article-title xml:lang="en"><![CDATA[Association of acute renal failure with mortality and complications in hospitalized patients with liver cirrhosis]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Castro-Serna]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hernández-Sánchez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zamora-Cervantes]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santamaría-Rodela]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[López-Hernández]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Secretaría de Salud de la Ciudad de México Hospital General Ticomán ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto de Seguridad Social del Estado de México y Municipios Hospital General de Ecatepec Dr. José María Rodríguez ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>02</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>02</month>
<year>2017</year>
</pub-date>
<volume>33</volume>
<numero>1</numero>
<fpage>41</fpage>
<lpage>47</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0186-48662017000100041&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0186-48662017000100041&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0186-48662017000100041&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  ANTECEDENTES:  la insuficiencia renal aguda es una de las complicaciones más severas de la cirrosis y conlleva un pronóstico ominoso. Los estudios que han utilizado definiciones más actuales de daño renal agudo, como AKIN (Acute Kidney Injury Network) o RIFLE (The Risk, Injury, Failure, Loss and End-stage kidney disease criteria) se enfocan en pacientes admitidos en unidades de cuidados intensivos y no pueden generalizarse a otros pacientes hospitalizados. El Club Internacional de Ascitis (ICA por sus siglas en inglés) recientemente adoptó una definición dinámica de insuficiencia renal crónica en pacientes con cirrosis, definiéndola como el incremento de la creatinina sérica mayor o igual de 0.3 mg/dL en las últimas 48 horas o un incremento de más de 50% de la creatinina basal conocida ocurrida en los últimos siete días, estadificándose de acuerdo con los incrementos de la creatinina.  OBJETIVO:  evaluar la repercusión de la severidad de la insuficiencia renal aguda de acuerdo con la clasificación del Club Internacional de Ascitis en la mortalidad de los pacientes con cirrosis hepática hospitalizados, así como conocer los principales desencadenantes de insuficiencia renal aguda en pacientes con cirrosis hepática hospitalizados, los patrones de recuperación o progresión de la misma.  PACIENTES Y MÉTODO:  estudio transversal, observacional, no aleatorizado y multicéntrico, en el que se utilizó la definición de insuficiencia renal aguda propuesta por el Club Internacional de Ascitis. Los pacientes se captaron en un lapso de cuatro meses, del 1 de abril al 31 de julio de 2015, en el Hospital General Ticomán y en el Hospital General de Ecatepec; se solicitó consentimiento informado de los pacientes o en caso pertinente, del familiar responsable del mismo. Se excluyeron los pacientes menores de 18 años, sujetos con insuficiencia hepática aguda y los pacientes con enfermedad renal crónica.  RESULTADOS: se incluyeron 45 pacientes con cirrosis hepática, de los que 36 eran hombres, con edad promedio de 46.2 años. La causa de la cirrosis hepática fue por alcohol en 40 pacientes (89%), viral en 3 (7%) y mixta en 2 (4%); la estadificación de insuficiencia renal aguda inicial fue: estadio 1: 36 (80%), estadio 2: 8 (18%) y estadio 3: 1 (2%). Ocurrieron siete defunciones (15.5%); de éstas, todos los pacientes estaban en la categoría C de la clasificación Child-Pugh, con insuficiencia renal aguda en estadio inicial 1; en 6 (13%) pacientes con progresión a estadio 3 y en estadio inicial 2; en 1 (2%) paciente con progresión a estadio 3. La severidad de la cirrosis en la escala MELD (Model for End-Stage Liver Disease) fue de 31.07±8.44 puntos en los pacientes que fallecieron versus 22.98±9.64 puntos (p=1.21) en los supervivientes. El puntaje de Child-Pugh en el grupo de pacientes fallecidos fue de 14.29±0.9 vs 0.29±2.31 en los supervivientes (p=0.001).  CONCLUSIONES:  la mortalidad en pacientes con cirrosis hepática e insuficiencia renal aguda fue más frecuente en pacientes con progresión al estadio de insuficiencia renal aguda y en sujetos con mayor severidad de la cirrosis hepática, valorada por Child-Pugh o por la escala MELD. Se requieren estudios de cohorte en nuestra población para validar la reciente clasificación del Club Internacional de Ascitis de la insuficiencia renal aguda en cirrosis y para determinar los factores asociados con incremento en la mortalidad en este grupo de pacientes.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  BACKGROUND:  Acute renal failure is one of the most severe complications of cirrhosis and entails a bad prognosis. The studies that had used most current definitions of acute kidney injury such as AKIN (Acute Kidney Injury Network) or RIFLE (The Risk, Injury, Failure, Loss and End-stage kidney disease criteria) has focused in patients admitted to the critical care units, and thus they can not be generalized to other hospitalized patients. Recently, the International Club of Ascites (ICA) adopted a dynamic definition of acute kidney failure in patient with cirrhosis, defined like increase of the creatinine level &#8805;0.3 mg/dL in the last 48 h; or a increase &#8805;50% from the basal creatinine in the last seven days, staged according the increase of creatinine.  OBJECTIVES:  To evaluate the impact of acute kidney injury severity according to the classification of the International Club of Ascites in the mortality of hospitalized patients with liver cirrhosis. To know the main triggers of acute kidney failure in hospitalized patients with liver cirrhosis, and to know the patterns of recovery and progression of renal failure.  PATIENTS AND METHOD:  A transversal, observational, no-randomized multicentric study designed. We used the definition of acute kidney failure proposed for the ICA. Patients were included from the General Hospital Ticoman and the General Hospital of Ecatepec in Mexico, in a four-month-period, from 1st April to 31st July of 2015; informed consent was obtained from the patients or in the pertinent case from the responsible familiar. Patients with less than 18 years old, with acute liver failure or chronic renal failure were excluded.  RESULTS:  They were included 45 patients with liver cirrhosis, 36 men, with a mean age of 46.2 years old. The etiology of the liver cirrhosis was alcohol in 40 patients (89%), viral in 3 (7%) and mixed in 2 (4%). The stage of acute liver failure was stage 1: 36 (80%), stage 2: 8 (18%) and stage 3: 1 (2%). Seven deaths occurred (15.5%), from there all the patients were classified in the C stage of the Child-Pugh Classification; death occurred with acute renal failure in initial stage 1; in 6 (13%) with progression to the stage 3 and in initial stage 2 in 1 (2%) with progression to stage 3. The severity of cirrhosis accord to the MELD classification was 31.07±8.44 points in the mortality cases, compared with 22.9±9.64 points (p=1.21) in the survivals. Child-Pugh score in the cases of death was 14.29±.9 vs 0.29±2.31 in survivals (p=0.001).  CONCLUSION:  Mortality in patients with liver cirrhosis and acute kidney failure was more frequent in patients with progression of the acute kidney failure, and in those with a more severe liver damage in the MELD or Child-Pugh scores. There are necessary cohort studies for the validation of the recent classification of the International Club of Ascites for Acute kidney failure in cirrhosis, and to determine the factors associated to the increase of mortality in this group of patients.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[insuficiencia renal aguda]]></kwd>
<kwd lng="es"><![CDATA[cirrosis hepática]]></kwd>
<kwd lng="es"><![CDATA[clasificación de la insuficiencia renal aguda]]></kwd>
<kwd lng="en"><![CDATA[acute kidney disease]]></kwd>
<kwd lng="en"><![CDATA[liver cirrhosis]]></kwd>
<kwd lng="en"><![CDATA[acute kidney failure classification]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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