Gender-Specific Renal Function and Urinary Syndrome in Patients with Liver Cirrhosis of Alcoholic Etiology: Observational Study

M. Krutikova, A. N. Vostrikova, E. F. Yakubova, L. Polskaya, S. Krutikov
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引用次数: 0

Abstract

Background. Gender has now been proven to have a significant impact on the development, course and outcome of a large number of diseases, including alcoholic liver disease. Alcohol consumption is one of the leading risk factors for various diseases. Alcohol-related diseases cause 10% of all deaths worldwide among young and middle-aged people. The occurrence of renal dysfunction in cirrhosis of the liver is an integral part of the natural course of the disease. At the moment, the diagnosis of gender-specific renal dysfunction that occurs against the background of liver cirrhosis is essential for the development of effective treatment strategies and the improvement of survival.Objectives. The study is aimed at identifying the features of the gender-specific renal function and urinary syndrome in patients with liver cirrhosis of alcoholic etiology and assessing the comprehensive prognostic significance of the indicators of common urine analysis in the diagnosis of renal dysfunction.Methods. An observational study was carried out using data from medical records of 158 patients with alcoholic liver cirrhosis (95 men and 63 women), aged 36 to 72 years, who were inpatients between February 2016 and March 2020. Physical examination and laboratory diagnostic data were taken into account. Binary predictors of renal dysfunction progression in patients with alcoholic liver cirrhosis were determined based on the analysis of descriptive statistics. Statistical data processing was performed using computer program Statistica 10 (StatSoft, Inc., USA) and standard Microsoft Excel software package (Microsoft Office 2016). Non-parametric statistical methods were used to describe the results. Quantitative results were analyzed using the Mann-Whitney test; comparison of two samples by a qualitatively defined feature was performed by means of the Fisher angular transformation method. Differences were considered significant at p ˂ 0.05. A multilayer neural network function from the Statistica 10 Neural Networks software was used to construct a classification scheme for renal dysfunction (yes/no). Neural network performance was assessed using descriptive and inductive statistics, calculating sensitivity, specificity, performing ROC analysis and constructing cumulative gains charts.Results. A renal function test revealed a significant decrease in glomerular filtration rate (p = 0.029) and a significant increase in urinary albumin/creatinine ratio (p < 0.0001) in women with alcoholic liver cirrhosis as compared with men. Women are also reported to have a high incidence of proteinuria, leukocyturia and bacteriuria. According to ROC-analysis, the urinalysis indicators have a high prognostic significance in identifying renal dysfunction in men and women with alcoholic liver cirrhosis (AUROC = 0.902 and sensitivity 81.82%, AUROC = 0.881 and sensitivity 75.00%, respectively).Conclusion. Renal dysfunction develops earlier and occurs twice as often in women with alcoholic cirrhosis than in men of the same age. The application of a neural network mechanism to predict renal dysfunction in men and women with alcoholic liver cirrhosis according to the indicators of urinalysis provides a high prognostic ability.
酒精性肝硬化患者性别特异性肾功能与尿路综合征的观察研究
背景性别现已被证明对包括酒精性肝病在内的许多疾病的发展、病程和结果有重大影响。饮酒是导致各种疾病的主要危险因素之一。与酒精有关的疾病导致全世界中青年死亡人数的10%。肝硬化患者肾功能障碍的发生是该疾病自然病程的一个组成部分。目前,对肝硬化背景下发生的性别特异性肾功能障碍的诊断对于制定有效的治疗策略和提高生存率至关重要。目标。本研究旨在确定酒精性肝硬化患者的性别特异性肾功能和泌尿系统综合征的特征,并评估常见尿液分析指标在肾功能障碍诊断中的综合预后意义。方法。一项观察性研究使用了158名酒精性肝硬化患者(95名男性和63名女性)的医疗记录数据,这些患者年龄在36至72岁之间,是2016年2月至2020年3月期间的住院患者。体格检查和实验室诊断数据都被考虑在内。基于描述性统计分析,确定了酒精性肝硬化患者肾功能障碍进展的二元预测因素。使用计算机程序Statistica 10(StatSoft,股份有限公司,USA)和标准Microsoft Excel软件包(Microsoft Office 2016)进行统计数据处理。使用非参数统计方法来描述结果。使用Mann-Whitney检验对定量结果进行分析;通过Fisher角度变换方法,通过定性定义的特征对两个样本进行比较。差异在p 0.05时被认为是显著的。来自Statistica 10 neural Networks软件的多层神经网络函数用于构建肾功能障碍的分类方案(是/否)。使用描述性和归纳统计学、计算灵敏度、特异性、进行ROC分析和构建累积增益图来评估神经网络性能。后果肾功能测试显示,与男性相比,患有酒精性肝硬化的女性肾小球滤过率显著降低(p=0.029),尿白蛋白/肌酐比值显著升高(p<0.0001)。据报道,女性蛋白尿、白细胞增多症和细菌尿的发病率也很高。根据ROC分析,尿液分析指标在识别酒精性肝硬化男性和女性的肾功能障碍方面具有很高的预后意义(AUROC=0.902,敏感性分别为81.82%,AUROC=0.881和75.00%)。结论患有酒精性肝硬化的女性肾功能障碍发展较早,发生频率是同龄男性的两倍。应用神经网络机制根据尿液分析指标预测酒精性肝硬化男性和女性的肾功能障碍提供了很高的预后能力。
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