Hepatorenal syndrome: Are we missing some prognostic factors?

Marco A Olivera-Martinez, Harlan Sayles, Renuga Vivekanandan, Sharlene D'Souza, Marius C Florescu

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Hepatorenal syndrome (HRS) is the functional renal failure associated with advanced cirrhosis and has also been described in fulminant hepatic failure. Without liver transplantation its prognosis is dismal. Our study included patients with type 1 HRS associated with cirrhosis, who were not liver transplant candidates. Aim: To identify variables associated with improved survival. Methods: Sixty-eight patients fulfilled the revised Ascites Club Criteria for type 1 HRS. None of them was suitable for liver transplantation. All the patients were treated with combinations of: albumin, midodrine and octreotide, pressors, and hemodialysis. Results: Median survival was 13 days for the whole group. Survival varied with the end-stage liver disease (ESLD) etiology: autoimmune, 49 days, cardiac cirrhosis, 22 days, idiopathic, 15.5 days, viral, 15 days, hepatitis C and alcohol, 14.5 days, alcohol 8 days, and neoplasia 4 days (p = 0.048). Survival of HRS associated with alcoholic liver disease versus other etiologies was not statistically significant (p = 0.1). Increased serum creatinine (p = 0.02) and urinary sodium 6-10 mEq/l (p = 0.027) at the initiation of therapy were prognostic factors for mortality. HRS treatment modalities (p = 0.73), use of dialysis (p = 0.56), dialysis modality (p = 0.35), use of vasopressors (p = 0.26), pre-existing renal disease (p = 0.49), gender (p = 0.90), and age (p = 0.57) were not associated with survival. Conclusions: We report for the first time ESLD etiology as a prognostic factor for survival. The renal function (expressed as serum creatinine) and urinary Na (<5 mEq/l) at the time of diagnosis were found to be associated with survival, suggesting that early treatment might increase survival.

Original languageEnglish (US)
Pages (from-to)210-214
Number of pages5
JournalDigestive Diseases and Sciences
Volume57
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Hepatorenal Syndrome
Survival
End Stage Liver Disease
Fibrosis
Liver Transplantation
Dialysis
Creatinine
Midodrine
Alcohols
Kidney
Alcoholic Liver Diseases
Preexisting Condition Coverage
Octreotide
Acute Liver Failure
Hepatitis C
Serum
Ascites
Renal Insufficiency
Renal Dialysis
Albumins

Keywords

  • Autoimmune hepatitis
  • Hemodialysis
  • Hepatorenal syndrome
  • Survival
  • Treatment

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Hepatorenal syndrome : Are we missing some prognostic factors? / Olivera-Martinez, Marco A; Sayles, Harlan; Vivekanandan, Renuga; D'Souza, Sharlene; Florescu, Marius C.

In: Digestive Diseases and Sciences, Vol. 57, No. 1, 01.2012, p. 210-214.

Research output: Contribution to journalArticle

Olivera-Martinez, Marco A ; Sayles, Harlan ; Vivekanandan, Renuga ; D'Souza, Sharlene ; Florescu, Marius C. / Hepatorenal syndrome : Are we missing some prognostic factors?. In: Digestive Diseases and Sciences. 2012 ; Vol. 57, No. 1. pp. 210-214.
@article{321ed2c786c14f7eaeae2dc407c0ec8f,
title = "Hepatorenal syndrome: Are we missing some prognostic factors?",
abstract = "Background: Hepatorenal syndrome (HRS) is the functional renal failure associated with advanced cirrhosis and has also been described in fulminant hepatic failure. Without liver transplantation its prognosis is dismal. Our study included patients with type 1 HRS associated with cirrhosis, who were not liver transplant candidates. Aim: To identify variables associated with improved survival. Methods: Sixty-eight patients fulfilled the revised Ascites Club Criteria for type 1 HRS. None of them was suitable for liver transplantation. All the patients were treated with combinations of: albumin, midodrine and octreotide, pressors, and hemodialysis. Results: Median survival was 13 days for the whole group. Survival varied with the end-stage liver disease (ESLD) etiology: autoimmune, 49 days, cardiac cirrhosis, 22 days, idiopathic, 15.5 days, viral, 15 days, hepatitis C and alcohol, 14.5 days, alcohol 8 days, and neoplasia 4 days (p = 0.048). Survival of HRS associated with alcoholic liver disease versus other etiologies was not statistically significant (p = 0.1). Increased serum creatinine (p = 0.02) and urinary sodium 6-10 mEq/l (p = 0.027) at the initiation of therapy were prognostic factors for mortality. HRS treatment modalities (p = 0.73), use of dialysis (p = 0.56), dialysis modality (p = 0.35), use of vasopressors (p = 0.26), pre-existing renal disease (p = 0.49), gender (p = 0.90), and age (p = 0.57) were not associated with survival. Conclusions: We report for the first time ESLD etiology as a prognostic factor for survival. The renal function (expressed as serum creatinine) and urinary Na (<5 mEq/l) at the time of diagnosis were found to be associated with survival, suggesting that early treatment might increase survival.",
keywords = "Autoimmune hepatitis, Hemodialysis, Hepatorenal syndrome, Survival, Treatment",
author = "Olivera-Martinez, {Marco A} and Harlan Sayles and Renuga Vivekanandan and Sharlene D'Souza and Florescu, {Marius C}",
year = "2012",
month = "1",
doi = "10.1007/s10620-011-1861-1",
language = "English (US)",
volume = "57",
pages = "210--214",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
publisher = "Springer New York",
number = "1",

}

TY - JOUR

T1 - Hepatorenal syndrome

T2 - Are we missing some prognostic factors?

AU - Olivera-Martinez, Marco A

AU - Sayles, Harlan

AU - Vivekanandan, Renuga

AU - D'Souza, Sharlene

AU - Florescu, Marius C

PY - 2012/1

Y1 - 2012/1

N2 - Background: Hepatorenal syndrome (HRS) is the functional renal failure associated with advanced cirrhosis and has also been described in fulminant hepatic failure. Without liver transplantation its prognosis is dismal. Our study included patients with type 1 HRS associated with cirrhosis, who were not liver transplant candidates. Aim: To identify variables associated with improved survival. Methods: Sixty-eight patients fulfilled the revised Ascites Club Criteria for type 1 HRS. None of them was suitable for liver transplantation. All the patients were treated with combinations of: albumin, midodrine and octreotide, pressors, and hemodialysis. Results: Median survival was 13 days for the whole group. Survival varied with the end-stage liver disease (ESLD) etiology: autoimmune, 49 days, cardiac cirrhosis, 22 days, idiopathic, 15.5 days, viral, 15 days, hepatitis C and alcohol, 14.5 days, alcohol 8 days, and neoplasia 4 days (p = 0.048). Survival of HRS associated with alcoholic liver disease versus other etiologies was not statistically significant (p = 0.1). Increased serum creatinine (p = 0.02) and urinary sodium 6-10 mEq/l (p = 0.027) at the initiation of therapy were prognostic factors for mortality. HRS treatment modalities (p = 0.73), use of dialysis (p = 0.56), dialysis modality (p = 0.35), use of vasopressors (p = 0.26), pre-existing renal disease (p = 0.49), gender (p = 0.90), and age (p = 0.57) were not associated with survival. Conclusions: We report for the first time ESLD etiology as a prognostic factor for survival. The renal function (expressed as serum creatinine) and urinary Na (<5 mEq/l) at the time of diagnosis were found to be associated with survival, suggesting that early treatment might increase survival.

AB - Background: Hepatorenal syndrome (HRS) is the functional renal failure associated with advanced cirrhosis and has also been described in fulminant hepatic failure. Without liver transplantation its prognosis is dismal. Our study included patients with type 1 HRS associated with cirrhosis, who were not liver transplant candidates. Aim: To identify variables associated with improved survival. Methods: Sixty-eight patients fulfilled the revised Ascites Club Criteria for type 1 HRS. None of them was suitable for liver transplantation. All the patients were treated with combinations of: albumin, midodrine and octreotide, pressors, and hemodialysis. Results: Median survival was 13 days for the whole group. Survival varied with the end-stage liver disease (ESLD) etiology: autoimmune, 49 days, cardiac cirrhosis, 22 days, idiopathic, 15.5 days, viral, 15 days, hepatitis C and alcohol, 14.5 days, alcohol 8 days, and neoplasia 4 days (p = 0.048). Survival of HRS associated with alcoholic liver disease versus other etiologies was not statistically significant (p = 0.1). Increased serum creatinine (p = 0.02) and urinary sodium 6-10 mEq/l (p = 0.027) at the initiation of therapy were prognostic factors for mortality. HRS treatment modalities (p = 0.73), use of dialysis (p = 0.56), dialysis modality (p = 0.35), use of vasopressors (p = 0.26), pre-existing renal disease (p = 0.49), gender (p = 0.90), and age (p = 0.57) were not associated with survival. Conclusions: We report for the first time ESLD etiology as a prognostic factor for survival. The renal function (expressed as serum creatinine) and urinary Na (<5 mEq/l) at the time of diagnosis were found to be associated with survival, suggesting that early treatment might increase survival.

KW - Autoimmune hepatitis

KW - Hemodialysis

KW - Hepatorenal syndrome

KW - Survival

KW - Treatment

UR - http://www.scopus.com/inward/record.url?scp=84856727091&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856727091&partnerID=8YFLogxK

U2 - 10.1007/s10620-011-1861-1

DO - 10.1007/s10620-011-1861-1

M3 - Article

C2 - 21850494

AN - SCOPUS:84856727091

VL - 57

SP - 210

EP - 214

JO - Digestive Diseases and Sciences

JF - Digestive Diseases and Sciences

SN - 0163-2116

IS - 1

ER -