Introduction: Hepatorenal syndrome [HRS] is a severe form of functional kidney failure that occurs in advanced liver cirrhosis and is associated with poor prognosis. Early recognition and management are crucial for improving outcomes. This study aimed to evaluate the prevalence, clinical characteristics, and short-term outcomes of HRS in patients with chronic liver disease.
Methods: This retrospective study included 270 patients with acute kidney injury and advanced liver cirrhosis who were hospitalized between January 2018 and December 2019. Patients meeting the diagnostic criteria for HRS were classified into HRS type 1 or HRS type 2. Treatment outcomes with terlipressin and albumin, as well as survival up to 90 days after treatment initiation, were analyzed.
Results: HRS was diagnosed in 32.6% of the studied cohort, with 40.9% having HRS type 1 and 59.1% having HRS type 2. The most common precipitating factor for HRS was large-volume paracentesis within the preceding four weeks [80.6% in HRS type 1 vs. 53.8% in HRS type 2; p = 0.010]. MELD scores were significantly higher in HRS type 1 [mean 32.0 ± 2.95] compared to HRS type 2 [mean 21.0 ± 2.45; p < 0.001]. A complete response to treatment was achieved in 31.8% of patients [13.9% in HRS type 1 vs. 44.2% in HRS type 2; p = 0.008]. The overall 90-day mortality rate was 72.7%, with significantly higher mortality in the HRS type 1 group [91.7%] compared to the HRS type 2 group [59.6%; p = 0.001].
Conclusion: HRS is a prevalent and severe complication of advanced liver disease. HRS type 1 is associated with worse clinical outcomes, emphasizing the need for prompt and aggressive management strategies.