Published online Dec 27, 2013. doi: 10.4254/wjh.v5.i12.685
Revised: September 26, 2013
Accepted: November 15, 2013
Published online: December 27, 2013
AIM: 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.
CONCLUSION: HRS still has a poor prognosis, even when vasoactive drug therapies are extensively used.
Core tip: Hepatorenal syndrome (HRS) is a life-threatening complication of advanced liver disease. The aims of this study were to investigate the clinical and biochemical features of HRS, to assess short- and long-term survival, and to evaluate the presence of potential predictors of early mortality. Thirty-three patients with liver cirrhosis and HRS were retrospectively reviewed. Median survival was 30 d. By univariate analysis Child-Pugh class C, hepatocellular carcinoma, low serum sodium, high bilirubin and high Model for End-stage Liver Disease (MELD) score were predictive factors of 30-d mortality. By multivariate analysis, only serum sodium < 132 mEq/L and MELD score > 27 were independently associated with survival of less than one month.