Degree of hepatic dysfunction and improvement of renal function predict survival in patients with HRS type I: a retrospective analysis.
BACKGROUND
Hepatorenal syndrome (HRS) is a frequent complication of end-stage liver cirrhosis. HRS type I has a very poor prognosis. From which of the more or less established therapies, such as use of vasoconstrictors together with albumin or placement of a Transjugular Intrahepatic Portosystemic Shunt patients might profit remains elusive. Therefore, it is important to define parameters that predict an improved outcome in respect to kidney function and survival.


METHODS
The clinical charts of 91 patients with cirrhosis and HRS type I were studied. The parameters associated with response to therapy, defined as a decrease in serum creatinine of more than 1.5 mg/dl on day 14 after diagnosis of HRS, and those associated with survival were assessed by multivariate analysis.


RESULTS
The median survival was 2.7 (1.5-3.8) months. Three independent predictive factors for survival were identified: Child-Pugh score (P = 0.05), Model of End-Stage Liver Disease (MELD) score less than 20 (P = 0.01), and response to therapy (P = 0.02). The Child-Pugh score (P = 0.00) and MELD score less than 20 (P = 0.02) were the parameters independently associated with the response to therapy, which occurred in 26% of the patients.


CONCLUSIONS
Our data of this large monocentric series with HRS type I confirm the poor prognosis in these patients, especially in those with high Child-Pugh and MELD scores, and in those in whom kidney function does not improve within 2 weeks.
Appenrodt
Beate
B
Department of Internal Medicine I, University of Bonn, Bonn, Germany. beate.appenrodt@ukb.uni-bonn.de
Zielinski
Julia
J
Brensing
Karl August
KA
Heller
Jörg
J
Sauerbruch
Tilman
T
Schepke
Michael
M
D000328:Adult; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006530:Hepatorenal Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011379:Prognosis; D016896:Treatment Outcome
D015415:Biomarkers; D003404:Creatinine