Prevalence and short-term outcome of hepatorenal syndrome: A 9-year experience in a high-complexity hospital in Colombia

Abstract

Background & aims Hepatorenal syndrome is a rare entity that is part of the complications of liver cirrhosis in its more severe stages. Without treatment, its mortality rate increases significantly. Terlipressin is considered to be the therapy of choice until the need of a liver transplant. The aim is to determine its prevalence, define patients' characteristics, triggers and 90-day survival, according to the type of managements established. Method This was a retrospective cohort study conducted in Colombia. It included patients with cirrhosis and acute kidney injury who met hepatorenal syndrome criteria, reaching 28 patients from 2007 to 2015. Groups were categorized according the type of hepatorenal syndrome and treatment. Demographic and trigger factors were evaluated to characterize the population. Treatment outcomes with terlipressin vs norepinephrine were analyzed up to a 90-day survival, using log Rank test. Continuous variables needed Student's T and Mann Whitney's U tests and categorical variables, Chi2 test. A value of p <0.05 and a power of 85% was considered. The data was analyzed in the SPSS version 23 software. Results 117 patients with cirrhosis developed renal injury; of these 23.9% were diagnosed with Hepatorenal Syndrome (67.8% type1; 32.1% type2). The presence of ascites was 100% in HRS2 and 84% in HRS1 (p = 0.296). The main trigger in both types was paracentesis greater than 5 liters in the last 4 weeks (39.3%). In total, 35% of the patients received renal replacement therapy and 14% underwent a hepatic transplant. Type 1 was more frequent (63% received terlipressin; 21% norepinephrine). The total complete response was 36%

Comparison Between Terlipressin and Catecholamine Infusion in the Management of Vasodilatory Shock: A Meta-Analysis of Randomized Controlled Trials

“…[41] On the contrary, a systematic review compared the effect of terlipressin versus norepinephrine in hepatorenal syndrome and found that norepinephrine leads to less adverse events and low mortality rates. [42] Our study also found out that terlipressin in vasodilatory shock resulted in a significant decrease in heart rate. This is a very valuable finding because it could mean that the development and/or progression of myocardial dysfunction associated with septic shock and tachycardia-induced cardiomyopathy could be prevented.…”

Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury

“…This study is limited by small sample size and low generalizability as only alcoholic cirrhotic patients were included. A recent randomized control trial evaluated triggers of development of HRS-1 (now known as HRS-AKI) vs. HRS-2 (as previously defined [ 7 ]) as a secondary outcome and demonstrated that the most common trigger for HRS-1 was unidentifiable triggers followed by paracentesis of >5 L in the last 4 weeks [ 26 ]. This study however utilizes the 2007 ICA diagnostic criteria for HRS which may result in an underdiagnosis of HRS-AKI given the requirement of serum creatinine to be ≥1.5 mg/dL…”

Impact of Palliative Care Services on Treatment and Resource Utilization for Hepatorenal Syndrome in the United States

“…Patients with hepatorenal syndrome type 1 typically present with a rapidly progressive decline in renal function, whereas steady progression of renal impairment over weeks to months is more common in hepatorenal syndrome type 2 [ 1 ]. The prevalence of hepatorenal syndrome ranges from 13–45% in patients with end-stage liver disease developing kidney dysfunctions [ 2 , 3 , 4 ]. The prognosis of hepatorenal syndrome is associated with increased mortality, with survival ranging from months for type 2 disease, to weeks to months for type 1 [ 1 , 5 ].…”