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Type‐1 hepatorenal syndrome associated with infections in cirrhosis: Natural history, outcome of kidney function, and survival
Author(s) -
Barreto Rogelio,
Fagundes Claudia,
Guevara Mónica,
Solà Elsa,
Pereira Gustavo,
Rodríguez Ezequiel,
Graupera Isabel,
MartínLlahí Marta,
Ariza Xavier,
Cárdenas Andrés,
Fernández Javier,
Rodés Juan,
Arroyo Vicente,
Ginès Pere
Publication year - 2014
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.26687
Subject(s) - hepatorenal syndrome , medicine , cirrhosis , gastroenterology , renal function , creatinine , septic shock , natural history , spontaneous bacterial peritonitis , bilirubin , complication , sepsis
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. (H epatology 2014;59:1505‐1513)