High age and low sodium urine concentration are associated with poor survival in patients with hepatorenal syndrome
Journal Title: Annals of Hepatology - Year 2013, Vol 12, Issue 1
Abstract
[b]Background[/b]. Combination therapy with terlipressin and albumin substitution is considered a widely accepted treatment regimen for patients with hepatorenal syndrome (HRS). However, only half of the patients respond to treatment and to date albumin substitution and terlipressin therapy are among the most expensive medical treatments available for patients with liver diseases. Thus, we aimed to identify clinical and etiological parameters to predict treatment response and overall mortality in patients with HRS. [b]Material and methods.[/b] We retrospectively evaluated 21 patients, 13 male/8 female, aged 43-72 years with HRS. Four patients were transplanted after following combination treatment. Terlipressin was administered by continuous intravenous perfusion (2-6 mg/d) and albumin drips (50 mg) were given daily. Treatment response was defined by a decrease in serum creatinine level to ≤ 1.5 mg/dL or by a ≥ 50% reduction of the baseline concentration. [b]Results[/b]. 57% of the patients responded to treatment, which was associated with improved survival at day 60, compared to non-responders. However, the overall mortality was not different between the two groups. Median age of 63 years was a significant negative predictor for therapy response. High baseline urinary sodium levels were of prognostic value for survival. The Model of End stage Liver Disease score (MELD score) did not correlate with therapy response. [b]Conclusion[/b]. In conclusion high age is a predictor of non-response. Low urinary sodium before treatment is associated with poor survival. Terlipressin and albumin co-treatment is associated with increased two-months survival rate. This seemingly moderate extension in survival rate can, however, be decisive for obtaining liver transplantation.
Authors and Affiliations
Matthias Hinz, Alexander Wree, Christoph Jochum, Lars Bechmann, Fuat Saner, Guido Gerken, Ali Canbay
Hospital performance reports based on severity adjusted mortality rates in patients with cirrhosis depend on the method of risk adjustment
Background. Hospital outcome report cards are used to judge provider performance, including for liver transplantation. We aimed to determine the impact of the choice of risk adjustment method on hospital rankings based...
Neuroendocrine metastatic tumors of the liver resembling hepatocellular carcinoma
Certain neuroendocrine tumors (NET) metastasized to the liver can resemble hepatocellular carcinoma (HCC) in cytological needle biopsy. Experience concerning the histologic characteristics of metastatic NET resembling HC...
Dorsal root ganglionopathy in a hepatitis C patient: a case report
We report an unusual clinical presentation of dorsal root ganglionopathy in a hepatitis C patient with negative cryoglobulins characterized by both motor and sensory symptoms. This mixed clinical picture in a hepatitis C...
Cell-based therapy to reverse advanced alcoholic liver fibrosis
Inter and intrapatient evolution of hepatitis C virus
Hepatitis C virus (HCV) has a short replication time, high mutation rates and large population sizes, all of which make it an excellent experimental model for evolution studies, because evolution can be visualized in rea...