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Poor Reversibility of Type 1 Hepatorenal Syndrome Associated with Infection

Summary and Comment |
April 22, 2014

Poor Reversibility of Type 1 Hepatorenal Syndrome Associated with Infection

  1. Atif Zaman, MD, MPH

Three-month survival in this subgroup of patients was only 21%. Early identification and treatment is essential.

  1. Atif Zaman, MD, MPH

In patients with cirrhosis who develop hepatorenal syndrome (HRS), especially type 1, morbidity and mortality are high. In many instances, the development of HRS is precipitated by bacterial infection, but little is known about outcomes and survival in this subgroup of patients.

From a large, prospective cohort study assessing kidney failure in patients with cirrhosis, researchers identified a subset of 70 patients with HRS type 1 with infection. HRS type 1 was defined as an increase in serum creatinine of >100% from baseline with a final value >2.5 mg/dL in less than 2 weeks without another cause identified. The infection had to be ongoing and without the presence of septic shock. Main outcomes were no reversibility of HRS type 1 (no decrease in creatinine to <1.5 mg/dL) and 3-month survival. Results were as follows:

  • In 71% of patients, the diagnosis of HRS type 1 was made concomitantly with that of the infection.

  • Two thirds of patients had infections other than spontaneous bacterial peritonitis, and 59% of the patients were culture-positive.

  • Two thirds of patients had no reversibility of their HRS type 1.

  • The main independent predictor of no HRS reversibility was lack of resolution of the infection despite antibiotic therapy (96% of patients with continued infection had no HRS reversibility vs. 48% without infection; P<0.001).

  • Overall 3-month survival was poor at 21%.

Comment

Hepatorenal syndrome type 1 was associated with a poor likelihood of reversibility and high mortality in patients with cirrhosis who had ongoing infection. This finding suggests that in clinical practice, we should be aggressive about identifying these patients and treating them early. Furthermore, it would be prudent to do the same for patients with cirrhosis who haven't developed HRS but are at risk. Further studies are needed to determine if a vasoconstrictor plus albumin is an effective therapy in this subset of patients with HRS type 1.

  • Disclosures for Atif Zaman, MD, MPH at time of publication Nothing to disclose

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