Evaluation of critical factors predicting the development of hepatorenal syndrome in hospitalized cirrhotic patients

Year 2025, Volume: 7 Issue: 1, 15 - 21, 10.01.2025

Çağdaş Erdoğan , Hulusi Can Karpuzcu

https://doi.org/10.38053/acmj.1523936

Abstract

Aims: This study aimed to determine the factors predicting the development of hepatorenal syndrome (HRS) in cirrhotic patients presenting with acute kidney injury (AKI).
Methods: We retrospectively analyzed 263 cirrhotic patients diagnosed with AKI between September 2022 and March 2024. Demographic characteristics, clinical findings, and laboratory results were analyzed. We diagnosed HRS using the 2019 International Club of Ascites criteria. We used bivariate and multivariate logistic regression models in our statistical analysis.
Results: HRS developed in 31 patients (11.8%). MELD-Na scores were significantly higher in the HRS group (28 vs. 18, p<0.05). In multivariate analysis, independent predictors of HRS development were history of ascites (OR 5.8, 95% CI 2.6-13.0), serum creatinine >2.5 mg/dl (OR 2.5, 95% CI 1.2-5.5), albumin <2 g/dl (OR 3.9, 95% CI 1.1-13.5), bilirubin >2 mg/dl (OR 7.9, 95% CI 3.7-17.0), and presence of spontaneous bacterial peritonitis (OR 5.5, 95% CI 1.4-12.2). Hemodialysis requirement (61.3% vs. 8.6%, p<0.05) and mortality rates (45.2% vs. 6.0%, p<0.05) were significantly higher in the HRS group.
Conclusion: This study revealed important factors predicting the development of HRS in cirrhotic patients presenting with AKI. These findings may help clinicians to identify high-risk patients early and develop appropriate treatment strategies.

Keywords

Hepatorenal syndrome, risk factors, acute kidney injury, hospitalization, liver cirrhosis

References

• Francoz C, Durand F, Kahn JA, Genyk YS, Nadim MK. Hepatorenal syndrome. Clin J Am Soc Nephrol. 2019;14(5):774-781.
• Diaconescu D, Pantea Stoian A, Socea LI, et al. Hepatorenal syndrome: a review. Arch Balk Med Union. 2018;53(2):239-245.
• Ginès P, Solà E, Angeli P, Wong F, Nadim MK, Kamath PS. Hepatorenal syndrome. Nat Rev Dis Primers. 2018;4(1):23.
• Ginès P, Guevara M, Arroyo V, Rodés J. Hepatorenal syndrome. Lancet. 2003;362(9398):1819-1827.
• Amin AA, Alabsawy EI, Jalan R, Davenport A, editors. Epidemiology, pathophysiology, and management of hepatorenal syndrome. Seminars in Nephrology; 2019: Elsevier.
• Arroyo V, Guevara M, Ginès P. Hepatorenal syndrome in cirrhosis: pathogenesis and treatment. Gastroenterology. 2002;122(6):1658-1676.
• Ginès A, Escorsell A, Ginès P, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993;105(1):229-236.
• Salerno F, Cazzaniga M, Merli M, et al. Diagnosis, treatment and survival of patients with hepatorenal syndrome: a survey on daily medical practice. J Hepatol. 2011;55(6):1241-1248.
• Sasso R, Abou Yassine A, Deeb L. Predictors of development of hepatorenal syndrome in hospitalized cirrhotic patients with acute kidney injury. J Clin Med. 2021;10(23):5621.
• Egerod Israelsen M, Gluud LL, Krag A. Acute kidney injury and hepatorenal syndrome in cirrhosis. J Gastroenterol Hepatol. 2015;30(2): 236-243.
• Cordoba J, Ventura-Cots M, Simón-Talero M, et al. Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF). J Hepatol. 2014;60(2):275-281.
• Møller S, Bendtsen F. Cirrhotic multiorgan syndrome. Dig Dis Sci. 2015; 60(11):3209-3225.
• Schleicher EM, Kremer WM, Kalampoka V, et al. Frailty as tested by the clinical frailty scale is a risk factor for hepatorenal syndrome in patients with liver cirrhosis. Clin Transl Gastroenterol. 2022;13(7):e00512.
• Angeli P, Bernardi M, Villanueva C, et al. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-460.
• Angeli P, Garcia-Tsao G, Nadim MK, Parikh CR. News in pathophysiology, definition and classification of hepatorenal syndrome: a step beyond the International Club of Ascites (ICA) consensus document. J Hepatol. 2019;71(4):811-822.
• Sánchez-Sánchez CY, Cazarin-Chávez K, Abendaño-Rivera DF, Higuera-De La Tijera MF, Santana-Vargas D, Pérez-Hernández JL. The role of cirrhosis etiology in the development of acute kidney injury and death. Annals Hepatol. 2024;29:101437.
• Velez JCQ, Therapondos G, Juncos LA. Reappraising the spectrum of AKI and hepatorenal syndrome in patients with cirrhosis. Nat Rev Nephrol. 2020;16(3):137-155.
• Møller S, Krag A, Bendtsen F. Kidney injury in cirrhosis: pathophysiological and therapeutic aspects of hepatorenal syndromes. Liver Int. 2014;34(8):1153-1163.
• Varga ZV, Matyas C, Paloczi J, Pacher P. Alcohol misuse and kidney injury: epidemiological evidence and potential mechanisms. Alcohol Res. 2017;38(2):283.
• Montoliu S, Ballesté B, Planas R, et al. Incidence and prognosis of different types of functional renal failure in cirrhotic patients with ascites. Clin Gastroenterol Hepatol. 2010;8(7):616-622.
• Curry MP, Vargas HE, Befeler AS, Pyrsopoulos NT, Patwardhan VR, Jamil K. Early treatment with terlipressin in patients with hepatorenal syndrome yields improved clinical outcomes in North American studies. Hepatol Commun. 2023;7(1):e1307.
• Janičko M, Veselíny E, Abraldes J, Jarčuška P. Serum sodium identifies patients with cirrhosis at high risk of hepatorenal syndrome. Z Gastroenterol. 2013;51(07):628-34.
• Oliveira AM, Branco JC, Barosa R, et al. Clinical and microbiological characteristics associated with mortality in spontaneous bacterial peritonitis: a multicenter cohort study. Eur J Gastroenterol Hepatol. 2016;28(10):1216-1222.
• El Sharawy SM, Elkadeem MZ, Amer IF. The Predictors of hepatorenal syndrome development in hcv cirrhotic ascitic egyptian patients with spontaneous bacterial peritonitis. Antiinflamm Antiallergy Agents Med Chem. 2023;22(1):58-66.
• Salerno F, Navickis RJ, Wilkes MM. Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis: a meta-analysis of randomized trials. Clin Gastroenterol Hepatol. 2013;11(2): 123-130. e1.