Longitudinal assessment of prognostic factors for patients with hepatorenal syndrome in a tertiary center

Abstract

Introduction Hepatorenal syndrome (HRS) is one of the serious complications in patients with advanced cirrhosis and ascites. In tertiary centers, most patients were classified as having type 1 HRS for their rapid progressive diseases. However, no significant predictors have been assessed previously for patients with type 1 HRS. In addition to the initial model of end-stage liver disease (MELD) scores and biochemistry parameters, we want to further investigate the prognostic importance of changes in MELD scores and biochemistry parameters over time for patients with type 1 HRS. Materials and methods Data from type 1 HRS patients were incorporated, including their demographic, clinical progression, all recording biochemical parameters, therapeutic methods, and outcomes. Results A total of 103 patients were included in our study. According to the definition of the International Ascites Club, 67 patients (or 65%) had type 1 HRS whereas 36 (or 35%) had type 2 HRS. According to the multivariate COX proportional hazards regression model, either initial biochemistry parameters or MELD scores were not significantly associated with prognosis. By time-dependent proportional hazards model, each point elevated in creatinine (CRE) and total bilirubin (TBI) levels during the admission increased mortality risk by 29 and 4%, respectively. Increasing albumin level during the admission showed its protective value. Changes in MELD score simple during the admission, which were calculated by CRE and TBI [3.8 9 log (bilirubin (mg/dl)] ? 9.6 9 log [Creatinine (mg/dl) ? 6.43], were significant predictor for patients with type 1 HRS. Conclusion In patients with type 1 HRS, changes in TBI, CRE, and albumin level during the admission were associated with prognosis. Changes in MELD score simple is superior to initial and changes in MELD scores to predict prognosis in patients with type 1 HRS.

Predictors of hepatorenal syndrome in alcoholic liver cirrhosis

“…These results are opposed to a large body of evidence showing that liver function parameters are the main mortality predictors in hepatorenal syndrome. A study by Yang et al showed that serum bilirubin, albumin, creatinin and MELD score were significantly associated with prognosis of patients with hepatorenal syndrome 20 . In our study, in contrast to the above papers, the results of univariate regression analysis suggest that parameters of liver function (total bilirubin, albumin, INR, MELD and MELD-Na score) as well as age, serum and urine sodium and creatinine are significant predictors of hepatorenal syndrome.…”

Neutrophil gelatinase‐associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study

“…Previous studies in HRS determined some prognostic markers as predictors of mortality including serum creatinine, low urine sodium, advanced age, MELD score and Cystatin C among others . To our knowledge, role of serum and/or urine NGAL has been assessed as a prognostic marker in patients with HRS in only one recent study .…”

Current position of vasoconstrictor and albumin infusion for type 1 hepatorenal syndrome

“…The International Ascites Club met in 2007 and set up a consensus on a new definition, diagnostic criteria and recommendation for the treatment of HRS . HRS is divided into two types: type 1 and type 2 HRS [2,3] . Type 1 HRS is typified by rapid deterioration of renal function as defined by a rising of serum creatinine level to over 2.5 mg/dL in less than 2 wk, and is characteristically presented as AKI [2][3][4][5] .…”

“…HRS is divided into two types: type 1 and type 2 HRS [2,3] . Type 1 HRS is typified by rapid deterioration of renal function as defined by a rising of serum creatinine level to over 2.5 mg/dL in less than 2 wk, and is characteristically presented as AKI [2][3][4][5] . Type 2 HRS runs a slower progressive clinical course with a median survival of 6 mo, and is classically associated with refractory ascites .…”

“…Patients with decompensated cirrhosis or acute on chronic liver failure who suffer from type 1 HRS would present with a critical illness, carrying a grave prognosis and having high mortality [5,6] . The consensus emphasized on the potential reversibility of type 1 HRS as a functional renal failure and the role of spontaneous bacterial peritonitis (SBP) as an important precipitating factor of HRS [2,3,5] . Contrasting with a previous consensus, this new definition gives an importance to HRS which was precipitated by SBP without ongoing shock.…”