title: Clinical course and prognostic factors of hepatorenal syndrome: A retrospective single-center cohort study.
abstract: OBJECTIVE
  To investigate clinical and biochemical features of hepatorenal syndrome (HRS), to assess short and long-term survival evaluating potential predictors of early mortality.
  
  
  METHODS
  Sixty-two patients with liver cirrhosis and renal failure, defined as a serum creatinine value > 1.5 mg/dL on at least two measurements within 48 h, admitted to our tertiary referral Unit from 2001 to 201, were retrospectively reviewed. Among them, 33 patients (53.2%) fulfilled the revised criteria of the International Ascites Club for the diagnosis of HRS. Twenty-eight patients were treated with combinations of terlipressin and albumin, two with dopamine and albumin, and three with albumin alone. No patients were suitable for liver transplantation. Complete response was defined as normalization of creatinine levels to less than 1.5 mg/dL, partial response as a decrease of at least 50% but not to less than 1.5 mg/dL, no response as no reduction in creatinine or a decrease of less 50% compared to pre-treatment values. All of the patients were followed up for at least 1 year until January 2013.
  
  
  RESULTS
  HRS type 1 was diagnosed in 15 patients (45.5%). Hepatitis C virus infection was the primary etiology (69.6%), followed by alcohol (15.2%), and cryptogenesis (15.2%). Complete response to therapy was obtained in only 3 cases (9.1%) and partial response in 7 patients (21.2%). Median survival was 30 d (range: 10-274) without significant differences between type 1 and type 2 HRS. By univariate analysis, Child-Pugh class C (P = 0.009), presence of hepatocellular carcinoma (P = 0.04), low serum sodium (P = 0.02), high bilirubin values (P = 0.009) and high Model for End-stage Liver Disease (MELD) score (P = 0.03) were predictive factors of 30-d mortality. By multivariate analysis, only serum sodium < 132 mEq/L (OR = 31.39; P = 0.02) and MELD score > 27 (OR = 18.72; P = 0.01) were independently associated with a survival of less than one month.
  
  
  CONCLUSIONS
  HRS still has a poor prognosis, even when vasoactive drug therapies are extensively used.
authors.affiliation: Anna Licata, Marcello Maida, Ambra Bonaccorso, Fabio Salvatore Macaluso, Maria Cappello, Antonio Craxì, Piero Luigi Almasio, Section of Gastroenterology, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, 290127 Palermo, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Licata
authors.affiliation: Anna Licata, Marcello Maida, Ambra Bonaccorso, Fabio Salvatore Macaluso, Maria Cappello, Antonio Craxì, Piero Luigi Almasio, Section of Gastroenterology, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, 290127 Palermo, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Maida
authors.affiliation: Anna Licata, Marcello Maida, Ambra Bonaccorso, Fabio Salvatore Macaluso, Maria Cappello, Antonio Craxì, Piero Luigi Almasio, Section of Gastroenterology, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, 290127 Palermo, Italy.
authors.forename: Ambra
authors.initials: A
authors.lastname: Bonaccorso
authors.affiliation: Anna Licata, Marcello Maida, Ambra Bonaccorso, Fabio Salvatore Macaluso, Maria Cappello, Antonio Craxì, Piero Luigi Almasio, Section of Gastroenterology, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, 290127 Palermo, Italy.
authors.forename: Fabio Salvatore
authors.initials: FS
authors.lastname: Macaluso
authors.affiliation: Anna Licata, Marcello Maida, Ambra Bonaccorso, Fabio Salvatore Macaluso, Maria Cappello, Antonio Craxì, Piero Luigi Almasio, Section of Gastroenterology, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, 290127 Palermo, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Cappello
authors.affiliation: Anna Licata, Marcello Maida, Ambra Bonaccorso, Fabio Salvatore Macaluso, Maria Cappello, Antonio Craxì, Piero Luigi Almasio, Section of Gastroenterology, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, 290127 Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
authors.affiliation: Anna Licata, Marcello Maida, Ambra Bonaccorso, Fabio Salvatore Macaluso, Maria Cappello, Antonio Craxì, Piero Luigi Almasio, Section of Gastroenterology, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, 290127 Palermo, Italy.
authors.forename: Piero Luigi
authors.initials: PL
authors.lastname: Almasio
keywords: Hepatitis C virus; Hepatorenal syndrome; Liver cirrhosis; Mortality; Vasoactive drugs