Degree of hepatic dysfunction and improvement of renal function predict survival in patients with HRS type I: a retrospective analysis

Background Hepatorenal syndrome (HRS) is a frequent complication of end-stage liver cirrhosis. HRS type I has a very poor prognosis. From which of the more or less established therapies, such as use of vasoconstrictors together with albumin or placement of a Transjugular Intrahepatic Portosystemic Shunt patients might profit remains elusive. Therefore, it is important to define parameters that predict an improved outcome in respect to kidney function and survival. Methods The clinical charts of 91 patients with cirrhosis and HRS type I were studied. The parameters associated with response to therapy, defined as a decrease in serum creatinine of more than 1.5 mg/dl on day 14 after diagnosis of HRS, and those associated with survival were assessed by multivariate analysis. Results The median survival was 2.7 (1.5-3.8) months. Three independent predictive factors for survival were identified: Child-Pugh score (P= 0.05), Model of End-Stage Liver Disease (MELD) score less than 20 (P=0.01), and response to therapy (P=0.02). The Child-Pugh score (P=0.00) and MELD score less than 20 (P=0.02) were the parameters independently associated with the response to therapy, which occurred in 26% of the patients. Conclusion Our data of this large monocentric series with HRS type I confirm the poor prognosis in these patients, especially in those with high Child-Pugh and MELD scores, and in those in whom kidney function does not improve within 2 weeks. Eur J Gastroenterol Hepatol 21:1428-1432 (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.