Study of the Predictive Factors of Hepato Renal Syndrome in Cirrhosis of Liver

Authors

  • Bikash Jaishi Associate professor, Department of Medicine (Liver Unit), National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal,
  • Sudhamshu KC Professor, Department of Medicine (Liver Unit), National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal,
  • Sandip Khadka Gastroenterologist, Department of Medicine (Liver Unit), National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal

Keywords:

Ascites, Cirrhosis, Hepato Renal Syndrome.

Abstract

Introduction: Cirrhosis is an anatomically diffuse process with fibrosis and nodule formation. Hepatorenal syndrome (HRS) is the development of renal failure in patients with severe liver disease in the absence of any identifiable renal pathology which is a functional rather than structural disturbance in renal function. Among the complications, ascites with HRS is one of the common complications, having high morbidity and mortality, with significant recurrence. This warrants to study the predictive factors of HRS in the cirrhosis of liver.

Method: This hospital based analytical, comparative study was conducted among 138 patients admitted in Liver Unit of Bir Hospital who fulfilled the inclusion criteria from April 2015 to March 2016. Hyponatremia (<130mEq/L), spontaneous bacterial peritonitis (SBP), low mean arterial pressure (MAP<80mmHg) and advanced liver diseases (Child-Pugh Score, CPS >11) were taken as predictive factors of HRS.

Result: Among 138 patients, 107(67%) were male and 31(23%) were female. The mean age was 49.99 (SD+/-11.7) years. Twenty four (17%) patients had HRS. Among SBP patients, 28 had no HRS and 4 had HRS (p=0.28). Among high CPS, 62 had no HRS and 17 had HRS (P=0.13). Among hyponatremia, 48 had no HRS and 14 had HRS (p=0.14). Among low MAP, 44 had no HRS and 14 had HRS (P=0.07). Nine patients with HRS and 20 without HRS (P=0.02), 6 with HRS and 35 without HRS (P=0.57), 22 with HRS and 106 without HRS (P=0.82) and 6 with HRS and 14 without HRS (P=0.10) had large volume paracentesis (LVP), SAH, low serum albumin (LSA) and upper gastro intestinal (UGI) bleeding respectively. The mean total bilirubin was 15.8mg% in HRS group and 9.08 mg% in no HRS group(p=0.02).

Conclusion: SBP, hyponatremia, high CPS and low MAP were not good predictors of HRS in cirrhosis but high bilirubin level, large volume paracentesis and high Model for End-stage Liver Disease (MELD) score had high tendency to develop HRS.

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Published

2020-12-25

Issue

Section

Orginal Articles