Renal failure and cirrhosis: A systematic review of mortality and prognosis

Background & Aims: To evaluate renal failure (RF) in cirrhosis to determine and quantify its prognostic significance. Methods: Studies were identified by MEDLINE, EMBASE, Cochrane, ISI Web of Science (1977-2010); search terms included renal failure, mortality, and cirrhosis. Included studies (n = 74) reported >10 patients and mortality data (8088 patients). Mortality at 1, 3, and 12 months was evaluated with respect to Child-Pugh score, serum creatinine, ascites, ICU status or sepsis, prospective study design, and publication year. Pooled odds ratio (POR) for death was compared for RF vs. non-RE (5668 patients). Results: Overall median mortality for RE patients was 67%: 58% at 1 month and 63% (IQR 54-79) at 12 months. POR for death RF vs. non-RE patients was 7.6 (95% CI 5.4-10.8). Overall mortality before 2005 (1264 patients) was 74% and after 2005 (2833 patients) was 63% with a marked reduction only at 30 days (71% vs. 52%). Conclusions: This study provides a measure of the increased risk of death in cirrhosis with renal failure. RE increases mortality 7-fold, with 50% of patients dying within one month. Preventative strategies for RF are needed. (c) 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.