Factors Related to Survival of Patients With Type 1 Hepatorenal Syndrome Treated With Renal Replacement Therapy
Background and objectives: The aim of the study was to analyze the etiology, course of dialysis treatment, outcomes and prognostic factors of survival in patients with hepatorenal syndrome (HRS) who received renal replacement therapy (RRT).
Materials and methods: The retrospective cross-sectional study included patients with HRS who received RRT at the Hospital of Lithuanian University of Health Sciences Kauno klinikos from 2010 to 2015 and met the International Ascites Club criteria for the diagnosis of HRS proposed in 2007. Variables obtained before the initiation of RRT were evaluated by univariate and multivariate analyses to identify prognostic factors of shorter survival.
Results: A total of 61 patients with type 1 HRS and liver cirrhosis (LC) were enrolled into the study. The main etiology of LC was alcoholic liver disease (45.9%). Precipitating factors for HRS were found in 39 cases (63.9%). The most common precipitating factors were a bacterial infection or spontaneous bacterial peritonitis (52.5%) and large volume paracentesis (> 4 L/day) performed without intravenous albumin replacement (18%). None of the patients survived. The mean survival time following the diagnosis of HRS was 18 ± 2.9 days. Independent risk factors associated with decreased survival time were hepatitis C virus (HCV) infection, PaO2/FiO2 ratio ≤ 164, mean arterial pressure (MAP) ≤ 70 mm Hg, mechanical ventilation at the initiation of RRT, serum urea level > 22 mmol/L and new model for end-stage liver disease (MELD)-Na score > 26 (P < 0.05).
Conclusions: Almost two-thirds of the HRS cases were associated with precipitating factors. Independent risk factors for shorter survival time in patients with type 1 HRS were HCV infection, low PaO2/FiO2 ratio, low MAP value, mechanical ventilation at the initiation of RRT, high serum urea level, and high MELD-Na score. The MELD-Na score could provide a better short-term survival prediction than MELD for patients with type 1 HRS.
Correspondence to L. Kievišienė Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania E-mail address: [email protected]