Hepatorenal syndrome: Are we missing some prognostic factors?

Marco Olivera Martinez, Harlan Sayles, Renuga Vivekanandan, Sharlene D'Souza, Marius C. Florescu

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Hepatorenal syndrome (HRS) is the functional renal failure associated with advanced cirrhosis and has also been described in fulminant hepatic failure. Without liver transplantation its prognosis is dismal. Our study included patients with type 1 HRS associated with cirrhosis, who were not liver transplant candidates. Aim: To identify variables associated with improved survival. Methods: Sixty-eight patients fulfilled the revised Ascites Club Criteria for type 1 HRS. None of them was suitable for liver transplantation. All the patients were treated with combinations of: albumin, midodrine and octreotide, pressors, and hemodialysis. Results: Median survival was 13 days for the whole group. Survival varied with the end-stage liver disease (ESLD) etiology: autoimmune, 49 days, cardiac cirrhosis, 22 days, idiopathic, 15.5 days, viral, 15 days, hepatitis C and alcohol, 14.5 days, alcohol 8 days, and neoplasia 4 days (p = 0.048). Survival of HRS associated with alcoholic liver disease versus other etiologies was not statistically significant (p = 0.1). Increased serum creatinine (p = 0.02) and urinary sodium 6-10 mEq/l (p = 0.027) at the initiation of therapy were prognostic factors for mortality. HRS treatment modalities (p = 0.73), use of dialysis (p = 0.56), dialysis modality (p = 0.35), use of vasopressors (p = 0.26), pre-existing renal disease (p = 0.49), gender (p = 0.90), and age (p = 0.57) were not associated with survival. Conclusions: We report for the first time ESLD etiology as a prognostic factor for survival. The renal function (expressed as serum creatinine) and urinary Na (<5 mEq/l) at the time of diagnosis were found to be associated with survival, suggesting that early treatment might increase survival.

Original languageEnglish (US)
Pages (from-to)210-214
Number of pages5
JournalDigestive Diseases and Sciences
Issue number1
StatePublished - Jan 2012


  • Autoimmune hepatitis
  • Hemodialysis
  • Hepatorenal syndrome
  • Survival
  • Treatment

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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