Renal failure and cirrhosis: a systematic review of mortality and prognosis

J Hepatol. 2012 Apr;56(4):810-8. doi: 10.1016/j.jhep.2011.10.016. Epub 2011 Dec 13.


Background & aims: To evaluate renal failure (RF) in cirrhosis to determine and quantify its prognostic significance.

Methods: Studies were identified by MEDLINE, EMBASE, Cochrane, ISI Web of Science (1977-2010); search terms included renal failure, mortality, and cirrhosis. Included studies (n=74) reported >10 patients and mortality data (8088 patients). Mortality at 1, 3, and 12 months was evaluated with respect to Child-Pugh score, serum creatinine, ascites, ICU status or sepsis, prospective study design, and publication year. Pooled odds ratio (POR) for death was compared for RF vs. non-RF (5668 patients).

Results: Overall median mortality for RF patients was 67%: 58% at 1 month and 63% (IQR 54-79) at 12 months. POR for death RF vs. non-RF patients was 7.6 (95%CI 5.4-10.8). Overall mortality before 2005 (1264 patients) was 74% and after 2005 (2833 patients) was 63% with a marked reduction only at 30 days (71% vs. 52%).

Conclusions: This study provides a measure of the increased risk of death in cirrhosis with renal failure. RF increases mortality 7-fold, with 50% of patients dying within one month. Preventative strategies for RF are needed.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Comorbidity
  • Female
  • Humans
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis / mortality*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Renal Insufficiency / diagnosis*
  • Renal Insufficiency / epidemiology
  • Renal Insufficiency / mortality*
  • Risk Factors
  • Severity of Illness Index
  • Time Factors