INCIDENCE PREDICTIVE FACTORS, AND PROGNOSIS OF THE HEPATORENAL SYNDROME IN CIRRHOSIS WITH ASCITES

Main Article Content

Abdul Qadir
Adam Khan
Basit Ali
Mohammad Umar
Muhammad Talha
Aamer Ahmad
Faizan Banaras

Keywords

Hepatorenal syndrome, Cirrhosis, Ascites, Predictive factors

Abstract

Background and Aim: Renal failure, especially in its acute phase, is common in patients with liver cirrhosis and ascites. The incidence of hepatorenal syndrome varies from 18% to 39% in a span of 1 to 5 years.  The present study aimed to determine the prevalence, predictive factors, and prognosis of hepatorenal syndrome (HRS) in cirrhosis with ascites.


Patients and Methods: This prospective study was carried out on 68 cirrhotic patients admitted for the treatment of ascites in the Departments of Nephrology and Gastroenterology, Khyber Teaching Hospital, Peshawar from January 2022 to December 2022. The median GFR, median values of serum sodium, and urine sodium concentrations were measured for each individual. All the patients underwent physical examination and detailed history. The abdominal tapped fluid was used to measure the concentration of protein ascetic fluid. Descriptive statistics were done in SPSS version 27.


Results: Of the total patients, there were 46 male and 22 females. The overall mean age was 48.64±4.8 years. Out of 68 patients, the incidence of cryptogenic cirrhosis and hepatitis B surface antigen (HBsAg)-positive cirrhosis was 76.5% (n=52) and 23.5% (n=16) respectively. Based on physical examination, the incidence of hepatomegaly, splenomegaly, and hepatic stigmata was 57.4% (n=39), 38.2% (n=26), and 79.4% (n=54) respectively. About 58.8% (n=40) patients had previous episodes of ascites. Gastrointestinal hemorrhage and hepatic encephalopathy was found in 26.5% (n=18) and 19.1% (n=13) respectively. Serum bilirubin levels increased in majority of patients 76.5% whereas serum albumin concentration decreased in 85.3% cases.


Conclusion: The present study found that HRS is a comparatively common complication in cirrhosis patients with ascites that is significantly associated with higher mortality rate and short survival rate. Hepatorenal syndrome could be easily predicted by plasma renin activity, liver size, and concentration of serum sodium.

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References

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