Comparison of hepatorenal syndrome incidence and outcomes using previous and current diagnostic criteria in cirrhotic patients.

Abstract

Background and aim: Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis with evolving diagnostic criteria. This study aimed to examine HRS prevalence, subtypes, and outcomes while comparing previous and current diagnostic criteria.

Materials and methods: This is a retrospective observational clinical study conducted on hospitalized patients with decompensated cirrhosis. Demographic characteristics, comorbidities, disease duration, disease severity, length of hospitalization, number of rehospitalizations, cirrhosis etiologies, laboratory data, and clinical outcomes were reviewed. The criteria from 2007 by the International Club of Ascites were the previous ones, with the 2015 criteria being the current criteria for diagnosing HRS. The incidence of HRS and its subtypes was determined, and the clinical characteristics of patients with and without HRS were compared using the Mann-Whitney U test.

Results: The study enrolled 212 patients, with a male predominance (57.5%) and a mean age of 63.4±14.5 years. A total of 32.1% of patients developed acute kidney injury (AKI), with prerenal azotemia being the most common type (76.5%), followed by intrinsic renal AKI (23.5%). Under the current criteria, 27 patients (12.7%) received an HRS diagnosis, while under the previous criteria, 16 patients (7.5%) received an HRS diagnosis, and the difference in diagnostic frequencies was statistically significant (p=0.046). In HRS cases, the MELD score (p=0.001), being classified as Child-Pugh C (p=0.043), rehospitalization (p=0.011), requiring intensive care (p=0.001), and creatinine levels (p<0.001) were higher.

Conclusion: AKI is common in hospitalized cirrhotic patients. The current HRS criteria identify more cases that need close monitoring compared to the previous criteria.