title: Diagnosis, treatment and survival of patients with hepatorenal syndrome: a survey on daily medical practice.
abstract: OBJECTIVE
  Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with ascites. The International Ascites Club recommended strict diagnostic criteria and treatment with vasoconstrictors and albumin. Aim of this prospective cohort study was to investigate the prevalence of HRS, diagnostic criteria, treatment and 3-month outcome in the daily-clinical-practice.
  
  
  METHODS
  Two-hundred-fifty-three patients with cirrhosis and renal failure consecutively admitted to 21 Italian hospitals were recruited.
  
  
  RESULTS
  The prevalence of HRS was 45.8% (30% type-1 and 15.8% type-2). In 36% of cases HRS was presumed because not all diagnostic criteria could be fulfilled. In 8% of cases HRS was superimposed on an organic nephropathy. Patients with HRS type-1 were younger and showed higher leukocyte count, higher respiratory rates, and worse liver function scores. Sixty-four patients with HRS type-1 received vasoconstrictors (40 terlipressin and 24 midodrine/octreotide). A complete response was obtained in 19 cases (30%) and a partial response in 13 (20%). Age was the only independent predictor of response (p=0.033). Three-month survival of patients with HRS type-1 was 19.7%. Survival was better in patients who responded to therapy. Age (p=0.017), bilirubin (p=0.012), and creatinine increase after diagnostic volume expansion (p=0.02) independently predicted death. The mortality rate was 97% among patients with at least two negative predictors.
  
  
  CONCLUSIONS
  The diagnostic criteria of HRS in our daily-clinical-practice could not be completely fulfilled in one third of cases. The treatment with vasoconstrictors and albumin was widely implemented. Mortality was strongly predicted by simple baseline variables.
authors.affiliation: Policlinico IRCCS San Donato, University of Milan, Italy. francesco.salerno@unimi.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.forename: Massimo
authors.initials: M
authors.lastname: Cazzaniga
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Spinzi
authors.forename: Simone
authors.initials: S
authors.lastname: Saibeni
authors.forename: Andrea
authors.initials: A
authors.lastname: Salmi
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.forename: Antonio
authors.initials: A
authors.lastname: Spadaccini
authors.forename: Elisa
authors.initials: E
authors.lastname: Trotta
authors.forename: Giacomo
authors.initials: G
authors.lastname: Laffi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Koch
authors.forename: Oliviero
authors.initials: O
authors.lastname: Riggio
authors.forename: Sergio
authors.initials: S
authors.lastname: Boccia
authors.forename: Martina
authors.initials: M
authors.lastname: Felder
authors.forename: Simona
authors.initials: S
authors.lastname: Balzani
authors.forename: Savino
authors.initials: S
authors.lastname: Bruno
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
mesh_terms: D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006530:Hepatorenal Syndrome / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000418:Albumins; D014662:Vasoconstrictor Agents