Type-1 hepatorenal syndrome associated with infections in cirrhosis: natural history, outcome of kidney function, and survival.

Abstract

UNLABELLED:

Type-1 hepatorenal syndrome (HRS) is a common complication of bacterial infections in cirrhosis, but its natural history remains undefined. To assess the outcome of kidney function and survival of patients with type-1 HRS associated with infections, 70 patients diagnosed during a 6-year period were evaluated prospectively. Main outcomes were no reversibility of type-1 HRS during treatment of the infection and 3-month survival. Forty-seven (67%) of the 70 patients had no reversibility of type-1 HRS during treatment of the infection. [Correction to previous sentence added March 10, 2014, after first online publication: "Twenty-three (33%)" was changed to "Forty-seven (67%)."] The main predictive factor of no reversibility of type-1 HRS was absence of infection resolution (no reversibility: 96% versus 48% in patients without and with resolution of the infection; P < 0.001). Independent predictive factors of no reversibility of type-1 HRS were age, high baseline serum bilirubin, nosocomial infection, and reduction in serum creatinine <0.3 mg/dL at day 3 of antibiotic treatment. No reversibility was also associated with severity of circulatory dysfunction, as indicated by more marked activity of the vasoconstrictor systems. In the whole series, 3-month probability of survival was only 21%. Factors associated with poor prognosis were baseline serum bilirubin, no reversibility of type-1 HRS, lack of resolution of the infection, and development of septic shock after diagnosis of type-1 HRS.

CONCLUSION:

Type-1 HRS associated with infections is not reversible in two-thirds of patients with treatment of infection only. No reversibility of type-1 HRS is associated with lack of resolution of the infection, age, high bilirubin, and no early improvement of kidney function and implies a poor prognosis. These results may help advance the management of patients with type-1 HRS associated with infections.

• Authors: Rogelio Barreto, Claudia Fagundes, Mónica Guevara, Elsa Solà, Gustavo Pereira, Ezequiel Rodríguez, Isabel Graupera, Marta Martín-Llahí, Xavier Ariza, Andrés Cárdenas, Javier Fernández, Juan Rodés, Vicente Arroyo, Pere Ginès
• Journal: Hepatology (Baltimore, Md.) (Hepatology) Vol. 59 Issue 4 Pg. 1505-13 (Apr 2014) ISSN: 1527-3350 [Electronic] United States
• PMID: 24037970 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 by the American Association for the Study of Liver Diseases.

Chemical References

• Anti-Bacterial Agents
• Creatinine
• Bilirubin

Topics

• Adult
• Age Factors
• Aged
• Anti-Bacterial Agents (therapeutic use)
• Bacterial Infections (complications, drug therapy)
• Bilirubin (blood)
• Creatinine (blood)
• Disease Management
• Female
• Follow-Up Studies
• Hepatorenal Syndrome (etiology, mortality, physiopathology)
• Humans
• Kidney (physiopathology)
• Liver Cirrhosis (complications, microbiology)
• Longitudinal Studies
• Male
• Middle Aged
• Prognosis
• Prospective Studies
• Retrospective Studies
• Survival Rate
• Treatment Outcome