Published online May 28, 2021. doi: 10.3748/wjg.v27.i20.2615
Peer-review started: November 13, 2020
First decision: February 11, 2021
Revised: February 23, 2021
Accepted: April 8, 2021
Article in press: April 8, 2021
Published online: May 28, 2021
Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with high mortality. It has a unique in vivo pathological environment compared with other end-stage liver diseases. Meanwhile, prognostic factors associated with prognosis of HRS are not rich enough, and current prognostic scoring systems for end-stage liver diseases need to be updated to fit the application in HRS.
As the diagnostic criteria for HRS were confusing before 2015, a multicenter retrospective study, strictly following the criteria proposed by the International Club of Ascites in 2015, was designed to systematically evaluate the evolution of HRS over the past decade at our institution and to figure out what affects the prognosis of HRS.
Our goal was to develop a novel scoring system to predict 28-d mortality of HRS and evaluate the accuracy, sensitivity, and specificity compared with other scoring systems, including Model for End-stage Liver Disease, Chronic Liver Failure-Sequential Organ Failure Assessment, and Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure.
Demographic/clinical variables and medical records of HRS patients from January 2011 to October 2019 were collected from four tertiary medical centers, and strict eligibility criteria were applied. The final analysis included 371 patients with HRS. Univariate and multivariate Cox regression analyses were performed for prediction modeling of HRS.
We found that five indicators can be used as prognostic factors for HRS, including gender, international normalized ratio, mean corpuscular hemoglobin concentration, neutrophil percentage, and stage (defined as a binary variable by the number of failed organs). They formed a new score, GIMNS, based on the weight coefficient. As the GIMNS increases, the risk of mortality gets higher. The sensitivity and specificity of GIMNS were much higher than those of Model for End-stage Liver Disease, Chronic Liver Failure-Sequential Organ Failure Assessment, and Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure in both the derivation and validation cohorts.
We innovatively defined a new variable, stage (based on the number of failed organs), to predict the prognosis of HRS. Importantly, we developed a new scoring system, GIMNS, which was specifically for patients with HRS and performed better than Model for End-stage Liver Disease, Chronic Liver Failure-Sequential Organ Failure Assessment, and Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure in accuracy, sensitivity, and specificity. As the five prognostic factors in GIMNS are easily available, clinical application of GIMNS could be more convenient.
The GIMNS scoring system should be validated in future prospective studies to get a more complete assessment.