title: High age and low sodium urine concentration are associated with poor survival in patients with hepatorenal syndrome.
abstract: BACKGROUND
  Combination therapy with terlipressin and albumin substitution is considered a widely accepted treatment regimen for patients with hepatorenal syndrome (HRS). However, only half of the patients respond to treatment and to date albumin substitution and terlipressin therapy are among the most expensive medical treatments available for patients with liver diseases. Thus, we aimed to identify clinical and etiological parameters to predict treatment response and overall mortality in patients with HRS.
  
  
  METHODS
  We retrospectively evaluated 21 patients, 13 male/8 female, aged 43-72 years with HRS. Four patients were transplanted after following combination treatment. Terlipressin was administered by continuous intravenous perfusion (2-6 mg/d) and albumin drips (50 mg) were given daily. Treatment response was defined by a decrease in serum creatinine level to ≤ 1.5 mg/dL or by a ≥ 50% reduction of the baseline concentration.
  
  
  RESULTS
  57% of the patients responded to treatment, which was associated with improved survival at day 60, compared to non-responders. However, the overall mortality was not different between the two groups. Median age of 63 years was a significant negative predictor for therapy response. High baseline urinary sodium levels were of prognostic value for survival. The Model of End stage Liver Disease score (MELD score) did not correlate with therapy response.
  
  
  CONCLUSIONS
  In conclusion high age is a predictor of non-response. Low urinary sodium before treatment is associated with poor survival. Terlipressin and albumin co-treatment is associated with increased two-months survival rate. This seemingly moderate extension in survival rate can, however, be decisive for obtaining liver transplantation.
authors.affiliation: University Hospital Essen, Department of Gastroenterology and Hepatology, Hufelandstrasse 55, 45122 Essen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hinz
authors.forename: Alexander
authors.initials: A
authors.lastname: Wree
authors.forename: Christoph
authors.initials: C
authors.lastname: Jochum
authors.forename: Lars P
authors.initials: LP
authors.lastname: Bechmann
authors.forename: Fuat
authors.initials: F
authors.lastname: Saner
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Gerbes
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000418:Albumins / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy / Q000401:mortality / Q000652:urine; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000652:urine; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012964:Sodium / Q000652:urine*; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D000418:Albumins; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D012964:Sodium; D003404:Creatinine