Prognostic importance of the cause of renal failure in patients with cirrhosis.
OBJECTIVE
The prognostic value of the different causes of renal failure in cirrhosis is not well established. This study investigated the predictive value of the cause of renal failure in cirrhosis.


METHODS
Five hundred sixty-two consecutive patients with cirrhosis and renal failure (as defined by serum creatinine > 1.5 mg/dL on 2 successive determinations within 48 hours) hospitalized over a 6-year period in a single institution were included in a prospective study. The cause of renal failure was classified into 4 groups: renal failure associated with bacterial infections, renal failure associated with volume depletion, hepatorenal syndrome (HRS), and parenchymal nephropathy. The primary end point was survival at 3 months.


RESULTS
Four hundred sixty-three patients (82.4%) had renal failure that could be classified in 1 of 4 groups. The most frequent was renal failure associated with infections (213 cases; 46%), followed by hypovolemia-associated renal failure (149; 32%), HRS (60; 13%), and parenchymal nephropathy (41; 9%). The remaining patients had a combination of causes or miscellaneous conditions. Prognosis was markedly different according to cause of renal failure, 3-month probability of survival being 73% for parenchymal nephropathy, 46% for hypovolemia-associated renal failure, 31% for renal failure associated with infections, and 15% for HRS (P < .0005). In a multivariate analysis adjusted for potentially confounding variables, cause of renal failure was independently associated with prognosis, together with MELD score, serum sodium, and hepatic encephalopathy at time of diagnosis of renal failure.


CONCLUSIONS
A simple classification of patients with cirrhosis according to cause of renal failure is useful in assessment of prognosis and may help in decision making in liver transplantation.
Martín-Llahí
Marta
M
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Guevara
Mónica
M
Torre
Aldo
A
Fagundes
Claudia
C
Restuccia
Tea
T
Gilabert
Rosa
R
Solá
Elsa
E
Pereira
Gustavo
G
Marinelli
Marcella
M
Pavesi
Marco
M
Fernández
Javier
J
Rodés
Juan
J
Arroyo
Vicente
V
Ginès
Pere
P
D000368:Aged; D001424:Bacterial Infections / Q000150:complications; D003404:Creatinine / Q000097:blood; D005260:Female; D006530:Hepatorenal Syndrome / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D012964:Sodium / Q000097:blood
D012964:Sodium; D003404:Creatinine