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Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry

Editor-in-Chief

ISSN (Print): 1871-5230
ISSN (Online): 1875-614X

Research Article

The Predictors of Hepatorenal Syndrome Development in HCV Cirrhotic Ascitic Egyptian Patients with Spontaneous Bacterial Peritonitis

Author(s): Shimaa Mahmoud El Sharawy, Mahmoud Zaki Elkadeem* and Ibrahim Fathi Amer

Volume 22, Issue 1, 2023

Published on: 07 August, 2023

Page: [58 - 66] Pages: 9

DOI: 10.2174/1871523022666230613160225

Price: $65

Abstract

Background & Aim: Spontaneous bacterial peritonitis is considered a precipitating factor for renal impairment in patients with liver cirrhosis. No specific study addressing this problem has been reported. This study aimed to detect the incidence and predictive factors of hepatorenal syndrome in these patients.

Materials and Methods: This study enrolled 121 hepatic cirrhotic patients with spontaneous bacterial peritonitis. History taking, clinical examination, and laboratory investigations including ascitic fluid analysis were carried out. Kidney function tests were repeated 3 days after the initiation of treatment. Patients were divided into 2 groups after one week of treatment during the follow-up period: Group I: patients without hepatorenal syndrome, and Group II: patients with hepatorenal syndrome. Multivariate analysis was performed to determine independent predictors of hepatorenal syndrome development.

Results: A total of 30 patients (24.8%) developed hepatorenal syndrome. Patients with hepatorenal syndrome had significantly lower sodium and albumin levels as well as higher creatinine, bilirubin, Child-Turcotte-Pugh score, portal vein diameter, Model for End-Stage Liver Disease score. Higher percentage of them had a history of recurrent spontaneous bacterial peritonitis and multiple therapeutic paracentesis of ascites. Multivariate analysis detected that serum bilirubin, Model for End-Stage Liver Disease-Sodium, and portal vein diameter were significant predictors of hepatorenal syndrome. Cutoff values were determined as 3.3 mg/dl for bilirubin, 15.9 mm for portal vein diameter, and 26 for Model for End-Stage Liver Disease-Sodium.

Conclusion: Hepatorenal syndrome is a common complication of spontaneous bacterial peritonitis. In our study, high serum bilirubin, Model for End-Stage Liver Disease-Sodium, and portal vein diameter are predictors of the development of hepatorenal syndrome in patients with spontaneous bacterial peritonitis.

Keywords: Liver cirrhosis, spontaneous bacterial peritonitis, hepatorenal syndrome, kidney, multivariate analysis, bilirubin.

Graphical Abstract
[1]
Lata, J.; Stiburek, O.; Kopacova, M. Spontaneous bacterial peritonitis: A severe complication ofliver cirrhosis. World J. Gastroenterol., 2009, 15(44), 5505-5510.
[http://dx.doi.org/10.3748/wjg.15.5505] [PMID: 19938187]
[2]
Tay, P.W.; Xiao, J.; Tan, D.J.; Ng, C.; Lye, Y.N.; Lim, W.H. An epidemiological meta-analysis on the worldwide prevalence, resistance, and outcomes of spontaneous bacterial peritonitis in cirrhosis. Front. Med., 2021, 5(8), 693652.
[http://dx.doi.org/10.3389/fmed.2021.693652]
[3]
Iliaz, R.; Ozpolat, T.; Baran, B.; Demir, K.; Kaymakoglu, S.; Besisik, F. Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers. Eur J Gastroen Hepat., 2018, 30, 786-787.
[http://dx.doi.org/10.1097/MEG.0000000000001111]
[4]
Schwabl, P.; Bucsics, T.; Soucek, K.; Mandorfer, M.; Bota, S.; Blacky, A.; Hirschl, A.M.; Ferlitsch, A.; Trauner, M.; Peck-Radosavljevic, M.; Reiberger, T. Risk factors for development of spontaneous bacterial peritonitis and subsequent mortality in cirrhotic patients with ascites. Liver Int., 2015, 35(9), 2121-2128.
[http://dx.doi.org/10.1111/liv.12795] [PMID: 25644943]
[5]
Wiest, R.; Krag, A.; Gerbes, A. Spontaneous bacterial peritonitis: recent guidelines and beyond. Gut, 2012, 61(2), 297-310.
[http://dx.doi.org/10.1136/gutjnl-2011-300779] [PMID: 22147550]
[6]
Bellot, P.; García-Pagán, J.C.; Francés, R.; Abraldes, J.G.; Navasa, M.; Pérez-Mateo, M.; Such, J.; Bosch, J. Bacterial DNA translocation is associated with systemic circulatory abnormalities and intrahepatic endothelial dysfunction in patients with cirrhosis. Hepatology, 2010, 52(6), 2044-2052.
[http://dx.doi.org/10.1002/hep.23918] [PMID: 20979050]
[7]
Albillos, A.; de la Hera, A.; González, M.; Moya, J.L.; Calleja, J.L.; Monserrat, J.; Ruiz-del-Arbol, L.; Alvarez-Mon, M. Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement. Hepatology, 2003, 37(1), 208-217.
[http://dx.doi.org/10.1053/jhep.2003.50038] [PMID: 12500206]
[8]
Gines, P.; Guevara, M.; Arroyo, V.; Rodes, J. Hepatorenal syndrome. Lancet, 2003, 362(9398), 1819-1827.
[http://dx.doi.org/10.1016/S0140-6736(03)14903-3]
[9]
Alessandria, C.; Ozdogan, O.; Guevara, M.; Restuccia, T.; Jiménez, W.; Arroyo, V.; Rodés, J.; Ginès, P. MELD score and clinical type predict prognosis in hepatorenal syndrome: Relevance to liver transplantation. Hepatology, 2005, 41(6), 1282-1289.
[http://dx.doi.org/10.1002/hep.20687] [PMID: 15834937]
[10]
Busk, T.M.; Bendtsen, F.; Møller, S. Hepatorenal syndrome in cirrhosis: diagnostic, pathophysiological, and therapeutic aspects. Expert Rev. Gastroenterol. Hepatol., 2016, 10(10), 1153-1161.
[http://dx.doi.org/10.1080/17474124.2016.1196132] [PMID: 27248461]
[11]
Allegretti, A.S.; Ortiz, G.; Wenger, J.; Deferio, J.J.; Wibecan, J.; Kalim, S.; Tamez, H.; Chung, R.T.; Karumanchi, S.A.; Thadhani, R.I. Prognosis of acute kidney injury and hepatorenal syndrome in patients with cirrhosis: a prospective cohort study. Int. J. Nephrol., 2015, 2015, 1-9.
[http://dx.doi.org/10.1155/2015/108139] [PMID: 26266048]
[12]
Jamil, K.; Huang, X.; Lovelace, B.; Pham, A.T.; Lodaya, K.; Wan, G. The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records. J. Med. Econ., 2019, 22(5), 421-429.
[http://dx.doi.org/10.1080/13696998.2019.1580201] [PMID: 30724682]
[13]
Salerno, F.; Gerbes, A.; Ginès, P.; Wong, F.; Arroyo, V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut, 2007, 56(9), 1310-1318.
[http://dx.doi.org/10.1136/gut.2006.107789] [PMID: 17389705]
[14]
Velez, J.C.Q.; Therapondos, G.; Juncos, L.A. Reappraising the spectrum of AKI and hepatorenal syndrome in patients with cirrhosis. Nat. Rev. Nephrol., 2020, 16(3), 137-155.
[http://dx.doi.org/10.1038/s41581-019-0218-4] [PMID: 31723234]
[15]
Angeli, P.; Garcia-Tsao, G.; Nadim, M.K.; Parikh, C.R. News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document. J. Hepatol., 2019, 71(4), 811-822.
[http://dx.doi.org/10.1016/j.jhep.2019.07.002] [PMID: 31302175]
[16]
Bashir, M.H.; Iqbal, S.; Miller, R.; Singh, J.; Mubarak, G.; Likhtshteyn, M.; Bigajer, E.; Gallagher, B.; Hurairah, A.; Stefanov, D.; McFarlane, S.I.; Ferstenberg, R. Management and outcomes of hepatorenal syndrome at an urban academic medical center: a retrospective study. Eur. J. Gastroenterol. Hepatol., 2019, 31(12), 1545-1549.
[http://dx.doi.org/10.1097/MEG.0000000000001462] [PMID: 31169567]
[17]
Belcher, J.M.; Garcia-Tsao, G.; Sanyal, A.J.; Bhogal, H.; Lim, J.K.; Ansari, N.; Coca, S.G.; Parikh, C.R. Association of AKI With mortality and complications in hospitalized patients with cirrhosis. Hepatology, 2013, 57(2), 753-762.
[http://dx.doi.org/10.1002/hep.25735] [PMID: 22454364]
[18]
Runyon, B.A. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 2013, 57(4), 1651-1653.
[http://dx.doi.org/10.1002/hep.26359] [PMID: 23463403]
[19]
Angeli, P.; Bernardi, M.; Villanueva, C.; Francoz, C.; Mookerjee, R.P.; Trebicka, J.; Krag, A.; Laleman, W.; Gines, P. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J. Hepatol., 2018, 69(2), 406-460.
[http://dx.doi.org/10.1016/j.jhep.2018.03.024] [PMID: 29653741]
[20]
Simonetto, D.A.; Gines, P.; Kamath, P.S. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ, 2020, 370, m2687.
[http://dx.doi.org/10.1136/bmj.m2687] [PMID: 32928750]
[21]
Pan, H.C.; Chien, Y.S.; Jenq, C.C.; Tsai, M.H.; Fan, P.C.; Chang, C.H.; Chang, M.Y.; Tian, Y.C.; Fang, J.T.; Yang, C.W.; Chen, Y.C. Acute kidney injury classification for critically ill cirrhotic patients: A comparison of the KDIGO, AKIN, and RIFLE classifications. Sci. Rep., 2016, 6(1), 23022.
[http://dx.doi.org/10.1038/srep23022] [PMID: 26983372]
[22]
Ahmed, O.; Rodrigues, D.M.; Brahmania, M.; Patel, K. Su1570-low incidence of spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhosis undergoing paracentesis: a systematic review and meta-analysis. Gastroenterology, 2018, 154(6), S-1181.
[http://dx.doi.org/10.1016/S0016-5085(18)33911-8]
[23]
Gerbes, A.L. Liver cirrhosis and kidney. Dig. Dis., 2016, 34(4), 387-390.
[http://dx.doi.org/10.1159/000444553] [PMID: 27170393]
[24]
Navasa, M.; Follo, A.; Filella, X.; Jiménez, W.; Francitorra, A.; Planas, R.; Rimola, A.; Arroyo, V.; Rodés, J. Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: Relationship with the development of renal impairment and mortality. Hepatology, 1998, 27(5), 1227-1232.
[http://dx.doi.org/10.1002/hep.510270507] [PMID: 9581675]
[25]
Sherman, D.S.; Fish, D.N.; Teitelbaum, I. Assessing renal function in cirrhotic patients: Problems and pitfalls. Am. J. Kidney Dis., 2003, 41(2), 269-278.
[http://dx.doi.org/10.1053/ajkd.2003.50035] [PMID: 12552488]
[26]
Angeli, P.; Ginès, P.; Wong, F.; Bernardi, M.; Boyer, T.D.; Gerbes, A.; Moreau, R.; Jalan, R.; Sarin, S.K.; Piano, S.; Moore, K.; Lee, S.S.; Durand, F.; Salerno, F.; Caraceni, P.; Kim, W.R.; Arroyo, V.; Garcia-Tsao, G. Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites. J. Hepatol., 2015, 62(4), 968-974.
[http://dx.doi.org/10.1016/j.jhep.2014.12.029] [PMID: 25638527]
[27]
Caregaro, L.; Menon, F.; Angeli, P.; Amodio, P.; Merkel, C.; Bortoluzzi, A.; Alberino, F.; Gatta, A. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis. Arch. Intern. Med., 1994, 154(2), 201-205.
[http://dx.doi.org/10.1001/archinte.1994.00420020117013] [PMID: 8285815]
[28]
Ruiz-del-Arbol, L.; Urman, J.; Fernández, J.; González, M.; Navasa, M.; Monescillo, A.; Albillos, A.; Jiménez, W.; Arroyo, V. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology, 2003, 38(5), 1210-1218.
[http://dx.doi.org/10.1053/jhep.2003.50447] [PMID: 14578859]
[29]
Wakani, A.J.; Awan, R.H.; Nayab, S.; Awan, K.H.; Awan, F.M. Renal impairment after Spontaneous Bacterial Peritonitis (SBP) in cirrhotic population. Prof. Med. J., 2019, 26(12), 2235-2240.
[http://dx.doi.org/10.29309/TPMJ/2019.26.12.4329]
[30]
Gameiro, J.; Agapito Fonseca, J.; Monteiro Dias, J.; Melo, M.J.; Jorge, S.; Velosa, J.; Lopes, J.A. Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers. Int. J. Nephrol. Renovasc. Dis., 2018, 11, 149-154.
[http://dx.doi.org/10.2147/IJNRD.S163602] [PMID: 29731657]
[31]
Follo, A.; Llovet, J.M.; Navasa, M.; Planas, R.; Forns, X.; Francitorra, A.; Rimola, A.; Gassull, M.A.; Arroyo, V.; Rodés, J. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: Incidence, clinical course, predictive factors and prognosis. Hepatology, 1994, 20(6), 1495-1501.
[http://dx.doi.org/10.1002/hep.1840200619] [PMID: 7982650]
[32]
Salgado, G.; Landa, M.; Masevicius, D.; Gianassi, S.; San-Román, J.E.; Silva, L.; Gimenez, M.; Tejerina, O.; Díaz-Cisneros, P.; Ciccioli, F.; do Pico, J.L. Acute renal failure according to the RIFLE and AKIN criteria: a multicenter study. Med. Intensiva, 2014, 38(5), 271-277.
[http://dx.doi.org/10.1016/j.medin.2013.04.007] [PMID: 24791648]
[33]
Fang, J.T.; Tsai, M.H.; Tian, Y.C.; Jenq, C.C.; Lin, C.Y.; Chen, Y.C.; Lien, J.M.; Chen, P.C.; Yang, C.W. Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure. Nephrol. Dial. Transplant., 2008, 23(6), 1961-1969.
[http://dx.doi.org/10.1093/ndt/gfm914] [PMID: 18187499]
[34]
Naveh, Y.; Finberg, J.P.M.; Kahana, L.; Better, O.S. Renin-angiotensin system in dogs following chronic bile-duct ligation. J. Hepatol., 1988, 6(1), 57-62.
[http://dx.doi.org/10.1016/S0168-8278(88)80462-8] [PMID: 3279106]
[35]
van Slambrouck, C.M.; Salem, F.; Meehan, S.M.; Chang, A. Bile cast nephropathy is a common pathologic finding for kidney injury associated with severe liver dysfunction. Kidney Int., 2013, 84(1), 192-197.
[http://dx.doi.org/10.1038/ki.2013.78] [PMID: 23486516]
[36]
Bräsen, J.H.; Mederacke, Y.S.; Schmitz, J.; Diahovets, K.; Khalifa, A.; Hartleben, B.; Person, F.; Wiech, T.; Steenbergen, E.; Großhennig, A.; Manns, M.P.; Schmitt, R.; Mederacke, I. Cholemic nephropathy causes acute kidney injury and is accompanied by loss of aquaporin 2 in collecting ducts. Hepatology, 2019, 69(5), 2107-2119.
[http://dx.doi.org/10.1002/hep.30499] [PMID: 30633816]
[37]
Nazar, A.; Pereira, G.H.; Guevara, M.; Martín-Llahi, M.; Pepin, M.N.; Marinelli, M.; Solá, E.; Baccaro, M.E.; Terra, C.; Arroyo, V.; Ginès, P. Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome. Hepatology, 2010, 51(1), 219-226.
[http://dx.doi.org/10.1002/hep.23283] [PMID: 19877168]
[38]
Chen, HA; Chen, YH; Zhao, H; Yi, SH; Zhang, JF; Meng, W Model for end-stage liver disease –sodium predicts prognosis in patients with chronic severe hepatitis B. Z hongua Wai Ke Za Zhi., 2009, 47(23), 1771-1774.
[39]
Borroni, G.; Maggi, A.; Sangiovanni, A.; Cazzaniga, M.; Salerno, F. Clinical relevance of hyponatraemia for the hospital outcome of cirrhotic patients. Dig. Liver Dis., 2000, 32(7), 605-610.
[http://dx.doi.org/10.1016/S1590-8658(00)80844-0] [PMID: 11142560]
[40]
Prohic, D.; Mesihovic, R.; Vanis, N.; Puhalovic, A. Prognostic significance of ascites and serum sodium in patients with low meld scores. Med. Arh., 2016, 70(1), 48-52.
[http://dx.doi.org/10.5455/medarh.2016.70.48-52] [PMID: 26980932]
[41]
Sanyal, A.J.; Bosch, J.; Blei, A.; Arroyo, V. Portal hypertension and its complications. Gastroenterology, 2008, 134(6), 1715-1728.
[http://dx.doi.org/10.1053/j.gastro.2008.03.007] [PMID: 18471549]
[42]
Bolognesi, M.; Di Pascoli, M.; Sacerdoti, D. Clinical role of non-invasive assessment of portal hypertension. World J. Gastroenterol., 2017, 23(1), 1-10.
[http://dx.doi.org/10.3748/wjg.v23.i1.1] [PMID: 28104976]
[43]
Coral, G.P.; Alves de Mattos, A. Renal impairment after spontaneous bacterial peritonitis: incidence and prognosis. Can. J. Gastroenterol., 2003, 17(3), 187-190.
[http://dx.doi.org/10.1155/2003/370257] [PMID: 12677269]
[44]
Sasso, R.; Abou Yassine, A.; Deeb, L. Predictors of development of hepatorenal syndrome in hospitalized cirrhotic patients with acute kidney injury. J. Clin. Med., 2021, 10(23), 5621.
[http://dx.doi.org/10.3390/jcm10235621] [PMID: 34884323]

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