952 MELD-SODIUM PREDICTS SURVIVAL AND DEVELOPMENT OF TYPE-1 HEPATORENAL SYNDROME IN PATIENTS WITH TYPE-2 HEPATORENAL SYNDROME

Abstract

Patients with type 2 hepatorenal syndrome (HRS) may develop type-1 HRS; however, the frequency and risk factors associated with the occurrence of this complication are currently unknown. With the aim of studying the risk factors associated with the development of type-1 HRS, 164 consecutive patients with cirrhosis and type-2 HRS were evaluated. The mean age was 62±10 years, 70% were male and 47% had alcoholic cirrhosis. At diagnosis, serum creatinine value was 1.77±0.25mg/dL, 57% patients had refractory ascites and 40% hyponatremia (serum sodium 131±5 mEq/L). Patients showed a marked deterioration in systemic hemodynamics and liver function, as evidenced by low mean arterial pressure (78±11mmHg), an increase in endogenous vasoactive systems activity (plasma renin activity 10.7±9ng/ml*h) and high values for MELD and MELD-sodium (18±5 and 23±5, respectively). At one year, only 34 patients were still alive, 29 had been transplanted and 92 had died. Thirty-nine patients (24%) developed type-1 HRS within a median of 65 days (95%CI 15– 117). Mean serum creatinine value at the time of diagnosis was 3.77±1.17mg/dL, which corresponded to mean an increase of 117% respect to baseline (95%CI 100–137%). No precipitating event was identified in 22 patients (56%). Bacterial infections were the most common precipitating factor of type-1 HRS (observed in 14 patients (37%). On multivariate analysis, MELD-Sodium was the only factor independently associated with survival and development of type-1 HRS, and the best cut-off point was 22. At 6 months, the incidence of type 1 HRS was significantly higher in patients with MELD-Sodium greater than or equal to 22, when compared to patients with MELD-Sodium lower than 22 (29 vs. 9%, p = 0.002). In conclusion, development of type-1 HRS is a frequent event in patients with type-2 HRS and occurs in absence of any precipitating event in almost half of cases. MELD-Sodium is a useful tool to predict both survival and development of type-1 HRS in this population. These results should be accounted not only on prediction of prognosis of these patients, but also for design of possible future therapeutic strategies.