Renal failure and cirrhosis: A systematic review of mortality and prognosis

Background & Aims

To evaluate renal failure (RF) in cirrhosis to determine and quantify its prognostic significance.

Methods

Studies were identified by MEDLINE, EMBASE, Cochrane, ISI Web of Science (1977–2010); search terms included renal failure, mortality, and cirrhosis. Included studies (n=74) reported >10 patients and mortality data (8088 patients). Mortality at 1, 3, and 12months was evaluated with respect to Child-Pugh score, serum creatinine, ascites, ICU status or sepsis, prospective study design, and publication year. Pooled odds ratio (POR) for death was compared for RF vs. non-RF (5668 patients).

Results

Overall median mortality for RF patients was 67%: 58% at 1month and 63% (IQR 54–79) at 12months. POR for death RF vs. non-RF patients was 7.6 (95%CI 5.4–10.8). Overall mortality before 2005 (1264 patients) was 74% and after 2005 (2833 patients) was 63% with a marked reduction only at 30days (71% vs. 52%).

Conclusions

This study provides a measure of the increased risk of death in cirrhosis with renal failure. RF increases mortality 7-fold, with 50% of patients dying within one month. Preventative strategies for RF are needed.

Abbreviations: RF, renal failure, MELD, model for end stage liver disease, HRS, hepatorenal syndrome, HCC, hepatocellular carcinoma, SBP, spontaneous bacterial peritonitis, SCr, serum creatinine, OR, odds ratio, POR, pooled odds ratios, CI, confidence interval