title: Renal failure and cirrhosis: a systematic review of mortality and prognosis.
abstract: OBJECTIVE
  To evaluate renal failure (RF) in cirrhosis to determine and quantify its prognostic significance.
  
  
  METHODS
  Studies were identified by MEDLINE, EMBASE, Cochrane, ISI Web of Science (1977-2010); search terms included renal failure, mortality, and cirrhosis. Included studies (n=74) reported >10 patients and mortality data (8088 patients). Mortality at 1, 3, and 12 months was evaluated with respect to Child-Pugh score, serum creatinine, ascites, ICU status or sepsis, prospective study design, and publication year. Pooled odds ratio (POR) for death was compared for RF vs. non-RF (5668 patients).
  
  
  RESULTS
  Overall median mortality for RF patients was 67%: 58% at 1 month and 63% (IQR 54-79) at 12 months. POR for death RF vs. non-RF patients was 7.6 (95%CI 5.4-10.8). Overall mortality before 2005 (1264 patients) was 74% and after 2005 (2833 patients) was 63% with a marked reduction only at 30 days (71% vs. 52%).
  
  
  CONCLUSIONS
  This study provides a measure of the increased risk of death in cirrhosis with renal failure. RF increases mortality 7-fold, with 50% of patients dying within one month. Preventative strategies for RF are needed.
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery - University College London and Royal Free Hospital, London, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fede
authors.forename: Gennaro
authors.initials: G
authors.lastname: D'Amico
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Arvaniti
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tsochatzis
authors.forename: Giacomo
authors.initials: G
authors.lastname: Germani
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Georgiadis
authors.forename: Alberto
authors.initials: A
authors.lastname: Morabito
authors.forename: Andrew Kenneth
authors.initials: AK
authors.lastname: Burroughs
mesh_terms: D015897:Comorbidity; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors