Prognostic Importance of the Cause of Renal Failure in Patients with Cirrhosis.
Gastroenterology. 2010 Jul 31;
Authors: MartÃn-Llahà M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R, Solá E, Pereira G, Marinelli M, Pavesi M, Fernández J, Rodés J, Arroyo V, Ginès P
BACKGROUND AND AIM:: The prognostic value of the different causes of renal failure in cirrhosis is not well established. The aim of this study was to investigate the predictive value of the cause of renal failure in cirrhosis. METHODS:: Five-hundred and sixty-two consecutive patients with cirrhosis and renal failure (as defined by serum creatinine>1.5 mg/dL on two successive determinations within 48 hours) hospitalized over a 6-year period in a single institution were included in a prospective study. The cause of renal failure was classified into four groups: renal failure associated with bacterial infections, renal failure associated with volume depletion, hepatorenal syndrome (HRS), and parenchymal nephropathy. The primary end-point was survival at 3 months. RESULTS:: Four-hundred and sixty-three patients (82.4%) had renal failure that could be classified in one of the four groups. The most frequent was renal failure associated with infections (213 cases; 46%), followed by hypovolemia-associated renal failure (149; 32%), HRS (60; 13%), and parenchymal nephropathy (41; 9%). The remaining patients had a combination of causes or miscellaneous conditions. Prognosis was markedly different according to the cause of renal failure, the 3-month probability of survival being 73% for parenchymal nephropathy, 46% for hypovolemia-associated renal failure, 31% for renal failure associated with infections, and 15% for HRS (p<0.0005). In a multivariate analysis adjusted for potentially-confounding variables, the cause of renal failure was independently associated with prognosis, together with MELD score, serum sodium, and hepatic encephalopathy at the time of diagnosis of renal failure. CONCLUSIONS:: A simple classification of patients with cirrhosis according to the cause of renal failure is useful in the assessment of prognosis and may help in decision making in liver transplantation.
PMID: 20682324 [PubMed - as supplied by publisher]