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Longitudinal assessment of prognostic factors for patients with hepatorenal syndrome in a tertiary center

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Abstract

Introduction

Hepatorenal syndrome (HRS) is one of the serious complications in patients with advanced cirrhosis and ascites. In tertiary centers, most patients were classified as having type 1 HRS for their rapid progressive diseases. However, no significant predictors have been assessed previously for patients with type 1 HRS. In addition to the initial model of end-stage liver disease (MELD) scores and biochemistry parameters, we want to further investigate the prognostic importance of changes in MELD scores and biochemistry parameters over time for patients with type 1 HRS.

Materials and methods

Data from type 1 HRS patients were incorporated, including their demographic, clinical progression, all recording biochemical parameters, therapeutic methods, and outcomes.

Results

A total of 103 patients were included in our study. According to the definition of the International Ascites Club, 67 patients (or 65%) had type 1 HRS whereas 36 (or 35%) had type 2 HRS. According to the multivariate COX proportional hazards regression model, either initial biochemistry parameters or MELD scores were not significantly associated with prognosis. By time-dependent proportional hazards model, each point elevated in creatinine (CRE) and total bilirubin (TBI) levels during the admission increased mortality risk by 29 and 4%, respectively. Increasing albumin level during the admission showed its protective value. Changes in MELD score simple during the admission, which were calculated by CRE and TBI [3.8 × log (bilirubin (mg/dl)] + 9.6 × log [Creatinine (mg/dl) + 6.43], were significant predictor for patients with type 1 HRS.

Conclusion

In patients with type 1 HRS, changes in TBI, CRE, and albumin level during the admission were associated with prognosis. Changes in MELD score simple is superior to initial and changes in MELD scores to predict prognosis in patients with type 1 HRS.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

    Ya-Wen Yang, Rey-Heng Hu, Ming-Chin Ho, Meng-Kun Tsai, Yao-Ming Wu & Po-Huang Lee

  2. Division of Nephrology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan

    Che-Hsiung Wu

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  1. Ya-Wen Yang
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  2. Che-Hsiung Wu
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  3. Rey-Heng Hu
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  6. Yao-Ming Wu
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  7. Po-Huang Lee
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Correspondence to Po-Huang Lee.

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Yang, YW., Wu, CH., Hu, RH. et al. Longitudinal assessment of prognostic factors for patients with hepatorenal syndrome in a tertiary center. Hepatol Int 4, 507–510 (2010). https://doi.org/10.1007/s12072-010-9180-8

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  • DOI: https://doi.org/10.1007/s12072-010-9180-8

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