Predicting mortality for hepatorenal syndrome with liver‐specific scores

Terres, Alana Zulian; Balbinot, Rafael Sartori; Muscope, Ana Laura Facco; Longen, Morgana Luisa; Schena, Bruna; Cini, Bruna Teston; Rost, Gilberto Luis; Balensiefer, Juline Isabel Leichtweis; Eberhardt, Louise Zanotto; Balbinot, Raul Angelo; Soldera, Jonathan

doi:10.1002/ygh2.429

Cited by 9 publications

(5 citation statements)

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“…For patients with ACLF and AEVH, 30-day mortality was 67.5%, considerably higher than the 33.9% described in the CANONIC study[ 19 ] and the 39% described in other studies[ 40 - 42 ]. For patients with ACLF diagnosed with Spontaneous Bacterial peritonitis, a 28-day-mortality of 65% has been described[ 43 , 44 ], while a 30-day mortality of 67.3% has been described for HRS patients[ 32 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…Once used to allocate organs for liver transplantation (LT), CTP is a score known by heart by every hepatologist, and helps allocate resources and adjust follow-up for both inpatients and outpatients. It is by large the most researched score, and is extremely important to prognosticate outpatients[ 34 , 35 ], intensive care patients[ 56 ] and hepatorenal syndrome patients[ 45 , 57 ]. In the present study, higher CTP has been independently associated with higher 90-day mortality.…”

Section: Discussionmentioning

confidence: 99%

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Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study

Terres¹,

Balbinot²,

Muscope³

et al. 2023

World J Clin Cases

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BACKGROUND Acute esophageal variceal hemorrhage (AEVH) is a common complication of cirrhosis and might precipitate multi-organ failure, causing acute-on-chronic liver failure (ACLF). AIM To analyze if the presence and grading of ACLF as defined by European Society for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) is able to predict mortality in cirrhotic patients presenting AEVH. METHODS Retrospective cohort study executed in Hospital Geral de Caxias do Sul. Data from medical records from 2010 to 2016 were obtained by searching the hospital electronic database for patients who received terlipressin. Medical records were reviewed in order to determine the diagnosis of cirrhosis and AEVH, including 97 patients. Kaplan-Meier survival analysis was used for univariate analysis and a stepwise approach to the Cox regression for multivariate analysis. RESULTS All- cause mortality for AEVH patients was 36%, 40.2% and 49.4% for 30-, 90- and 365-day, respectively. The prevalence of ACLF was 41.3%. Of these, 35% grade 1, 50% grade 2 and 15% grade 3. In multivariate analysis, the non-use of non-selective beta-blockers, presence and higher grading of ACLF and higher Model for End-Stage Liver Disease scores were independently associated with higher mortality for 30-day with the addition of higher Child-Pugh scores for 90-day period. CONCLUSION Presence and grading of ACLF according to the EASL-CLIF criteria was independently associated with higher 30- and 90-day mortality in cirrhotic patients admitted due to AEVH.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study

Terres¹,

Balbinot²,

Muscope³

et al. 2023

World J Clin Cases

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“…HRS is a potentially preventable but serious complication of advanced liver cirrhosis and is associated with a high mortality rate [ 7 , 8 ]. Although several complex tools exist for risk assessment, prognostication, and prediction of mortality in liver cirrhosis, none exists for predicting HRS, which is universally considered the standard.…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous albumin infusion decreased the risk of renal impairment in patients with liver cirrhosis and SBP [ 9 ]. It is known that early identification and prompt initiation of treatment for HRS could lead to improved survival, hence making the pursuit of reliable prognostic markers an important field of study [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Abstinence from alcohol plays a critical role in the reversal and improvement of HRS in patients with alcoholic liver cirrhosis as the underlying etiology [ 14 ]. Other treatment options for HRS include the use of vasoconstrictors and albumin, which improve short-term survival and renal function, especially in patients awaiting liver transplantation [ 7 , 9 ]. Norepinephrine and terlipressin are equally effective vasoconstrictors, although terlipressin is associated with a higher risk of side effects and is more expensive [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Deranged Biochemical Markers As Early Predictors for the Development of Hepatorenal Syndrome in Patients With Alcoholic Liver Cirrhosis

Deorukhkar,

Sonawale,

Goyal

et al. 2023

Cureus

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Objective To investigate predictive biomarkers correlated with the onset of hepatorenal syndrome (HRS) in individuals with alcoholic liver cirrhosis using various factors, including age, sex, and laboratory indicators such as serum sodium, bilirubin, PT/INR, and albumin levels. Additionally, we sought to establish a correlation between the occurrence of hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and the model for end-stage liver disease (MELD) score at the time of diagnosis and the development of HRS in cirrhotic patients. Methods This cross-sectional study spanned 12 months and included a total of 83 patients as its sample size. This study was conducted at the Department of Internal Medicine, a tertiary care hospital situated in Mumbai, India. Two distinct groups were formed: one consisted of patients diagnosed with HRS, and the other group comprised patients with alcoholic liver cirrhosis but without HRS. This study aimed to investigate potential relationships with the suggested risk factors. To discern statistically meaningful distinctions among categorical variables, the chi-square test was employed, whereas for continuous variables, analysis of variance (ANOVA) was used. Only patients who provided written informed consent were included in this study. Results No correlation was found between patients with and without HRS with respect to age (p=0.056) and sex (p=0.067). The presence of HE (p<0.001), SBP (p=0.021), hyponatremia (p=0.0001), hypoalbuminemia (p<0.0001), higher PT/INR (p=0.03), and higher MELD score (p=0.0002) were found to be correlated with an increased risk of developing HRS. Hyperbilirubinemia was not correlated with an increased risk of developing HRS (p=0.157). Conclusions HRS is a severe and potentially avoidable complication associated with advanced liver cirrhosis, characterized by a notably high mortality rate. By closely monitoring key biomarkers, such as serum sodium, PT/INR, and albumin levels, in addition to assessing the presence of SBP and HE during the initial presentation of patients with alcoholic cirrhosis, medical professionals may be able to identify those at a heightened risk of developing HRS. This, in turn, enables the swift diagnosis and implementation of aggressive treatment strategies. Such measures not only hold the potential to reverse HRS but also enhance survival rates among individuals with alcoholic liver cirrhosis, thereby increasing the pool of candidates eligible for liver transplantation, which remains the cornerstone of treatment.

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Predicting mortality for cirrhotic patients with acute oesophageal variceal haemorrhage using liver‐specific scores

et al. 2021

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Predicting mortality for hepatorenal syndrome with liver‐specific scores

Abstract: Previous presentation: Residency conclusion thesis for Alana Zulian Terres in 2018. Partial data presented as an oral presentation in Semana Brasileira do Aparelho Digestivo, November-2018.

Cited by 9 publications

References 69 publications

Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study

Acute-on-chronic liver failure is independently associated with higher mortality for cirrhotic patients with acute esophageal variceal hemorrhage: Retrospective cohort study

Deranged Biochemical Markers As Early Predictors for the Development of Hepatorenal Syndrome in Patients With Alcoholic Liver Cirrhosis

Predicting mortality for cirrhotic patients with acute oesophageal variceal haemorrhage using liver‐specific scores

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