title: Type-1 hepatorenal syndrome associated with infections in cirrhosis: natural history, outcome of kidney function, and survival.
abstract: Type-1 hepatorenal syndrome (HRS) is a common complication of bacterial infections in cirrhosis, but its natural history remains undefined. To assess the outcome of kidney function and survival of patients with type-1 HRS associated with infections, 70 patients diagnosed during a 6-year period were evaluated prospectively. Main outcomes were no reversibility of type-1 HRS during treatment of the infection and 3-month survival. Forty-seven (67%) of the 70 patients had no reversibility of type-1 HRS during treatment of the infection. [Correction to previous sentence added March 10, 2014, after first online publication: "Twenty-three (33%)" was changed to "Forty-seven (67%)."] The main predictive factor of no reversibility of type-1 HRS was absence of infection resolution (no reversibility: 96% versus 48% in patients without and with resolution of the infection; P < 0.001). Independent predictive factors of no reversibility of type-1 HRS were age, high baseline serum bilirubin, nosocomial infection, and reduction in serum creatinine <0.3 mg/dL at day 3 of antibiotic treatment. No reversibility was also associated with severity of circulatory dysfunction, as indicated by more marked activity of the vasoconstrictor systems. In the whole series, 3-month probability of survival was only 21%. Factors associated with poor prognosis were baseline serum bilirubin, no reversibility of type-1 HRS, lack of resolution of the infection, and development of septic shock after diagnosis of type-1 HRS.
  
  
  CONCLUSIONS
  Type-1 HRS associated with infections is not reversible in two-thirds of patients with treatment of infection only. No reversibility of type-1 HRS is associated with lack of resolution of the infection, age, high bilirubin, and no early improvement of kidney function and implies a poor prognosis. These results may help advance the management of patients with type-1 HRS associated with infections.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Barcelona, Spain; Instituto Reina Sofía de Investigación Nefrológica, Barcelona, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Barreto
authors.forename: Claudia
authors.initials: C
authors.lastname: Fagundes
authors.forename: Mónica
authors.initials: M
authors.lastname: Guevara
authors.forename: Elsa
authors.initials: E
authors.lastname: Solà
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pereira
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Rodríguez
authors.forename: Isabel
authors.initials: I
authors.lastname: Graupera
authors.forename: Marta
authors.initials: M
authors.lastname: Martín-Llahí
authors.forename: Xavier
authors.initials: X
authors.lastname: Ariza
authors.forename: Andrés
authors.initials: A
authors.lastname: Cárdenas
authors.forename: Javier
authors.initials: J
authors.lastname: Fernández
authors.forename: Juan
authors.initials: J
authors.lastname: Rodés
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy; D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000097:blood; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006530:Hepatorenal Syndrome / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000382:microbiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D003404:Creatinine; D001663:Bilirubin