Degree of hepatic dysfunction and improvement of renal function predict survival in patients with HRS type I: a retrospective analysis

Eur J Gastroenterol Hepatol. 2009 Dec;21(12):1428-32. doi: 10.1097/MEG.0b013e32832ec16a.


Background: Hepatorenal syndrome (HRS) is a frequent complication of end-stage liver cirrhosis. HRS type I has a very poor prognosis. From which of the more or less established therapies, such as use of vasoconstrictors together with albumin or placement of a Transjugular Intrahepatic Portosystemic Shunt patients might profit remains elusive. Therefore, it is important to define parameters that predict an improved outcome in respect to kidney function and survival.

Methods: The clinical charts of 91 patients with cirrhosis and HRS type I were studied. The parameters associated with response to therapy, defined as a decrease in serum creatinine of more than 1.5 mg/dl on day 14 after diagnosis of HRS, and those associated with survival were assessed by multivariate analysis.

Results: The median survival was 2.7 (1.5-3.8) months. Three independent predictive factors for survival were identified: Child-Pugh score (P = 0.05), Model of End-Stage Liver Disease (MELD) score less than 20 (P = 0.01), and response to therapy (P = 0.02). The Child-Pugh score (P = 0.00) and MELD score less than 20 (P = 0.02) were the parameters independently associated with the response to therapy, which occurred in 26% of the patients.

Conclusion: Our data of this large monocentric series with HRS type I confirm the poor prognosis in these patients, especially in those with high Child-Pugh and MELD scores, and in those in whom kidney function does not improve within 2 weeks.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Creatinine / blood
  • Epidemiologic Methods
  • Female
  • Hepatorenal Syndrome / diagnosis*
  • Hepatorenal Syndrome / etiology
  • Hepatorenal Syndrome / physiopathology
  • Hepatorenal Syndrome / therapy
  • Humans
  • Kidney / physiopathology
  • Liver Cirrhosis / complications
  • Male
  • Middle Aged
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Prognosis
  • Treatment Outcome


  • Biomarkers
  • Creatinine