title: Intrarenal resistance index as a prognostic parameter in patients with liver cirrhosis compared with other hepatic scoring systems.
abstract: OBJECTIVE
  Patients with advanced liver cirrhosis who develop renal dysfunction have a poor prognosis. Elevated intrarenal resistance indices (RIs) due to renal vascular constriction have been described before in cirrhotic patients. In the current study, we prospectively investigated the course of intrarenal RIs and compared their prognostic impact with those of the Model for End-Stage Liver Disease (MELD) and the Child-Pugh scores.
  
  
  METHODS
  Sixty-three patients with liver cirrhosis underwent a baseline visit which included a sonographic examination and laboratory tests. Forty-four patients were prospectively monitored. The end points were death or survival at the day of the follow-up visit.
  
  
  RESULTS
  In 28 patients, a follow-up visit was performed after 22 ± 8 months (group 1). Sixteen patients died during follow-up after 12 ± 8 months (group 2). Group 2 patients showed a significantly higher baseline RI (0.76 ± 0.05) than group 1 patients (RI = 0.72 ± 0.06; p < 0.05). As shown by receiver operating characteristic analysis, the RI and the MELD score achieved similar sensitivity and specificity [area under the curve (AUC): 0.722; 95% confidence interval (95% CI): 0.575-0.873 vs. AUC: 0.724; 95% CI: 0.575-0.873, z = 0.029, n.s.] in predicting survival and were superior to the Child-Pugh score (AUC: 0.677; 96% CI: 0.518-0.837).
  
  
  CONCLUSIONS
  The RI is not inferior in sensitivity and specificity to the MELD score. Cirrhotic patients with elevated RIs have impaired short- and long-term survival. The RI may help identify high-risk patients that require special therapeutic care.
authors.affiliation: Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany. manuela.goetzberger@med.uni-muenchen.de
authors.forename: M
authors.initials: M
authors.lastname: Götzberger
authors.forename: J
authors.initials: J
authors.lastname: Singer
authors.forename: C
authors.initials: C
authors.lastname: Kaiser
authors.forename: V
authors.initials: V
authors.lastname: Gülberg
mesh_terms: D000368:Aged; D019540:Area Under Curve; D058625:End Stage Liver Disease / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012079:Renal Circulation; D012720:Severity of Illness Index; D014463:Ultrasonography; D014655:Vascular Resistance