The hepatorenal syndrome is one of various potential causes of acute kidney injury in patients with decompensated liver disease. NUTRIC revealed a moderate advantage in prognostic ability compared to mNUTRIC.
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NUTRIC and mNUTRIC are characterized by high prognostic accuracy in critically ill patients with cirrhosis. We found a significant association of NUTRIC and mNUTRIC with MELD, CHILD, renal function, interleukin 6 and albumin, but not with body mass index. 0.788) as well as 3-month mortality (area under curve 0.839 vs. NUTRIC was moderately superior to mNUTRIC in prediction of 28-day mortality (area under curve 0.806 vs. High nutritional risk was linked to disease severity and poor outcome. On ICU admission, a large proportion of 65% were classified as high NUTRIC (6–10) and 75% were categorized as high mNUTRIC (5–9). Comparative prognostic analyses between NUTRIC and mNUTRIC were assessed in 114 patients. We performed a retro-prospective evaluation in 150 Caucasian cirrhotic patients admitted to our ICU.
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Considering the high mortality of cirrhosis in critically ill patients, this study aims to evaluate the discriminative ability of NUTRIC and mNUTRIC to predict outcome. The Nutrition Risk in Critically ill (NUTRIC) score and its modified variant (mNUTRIC) were established to assess the nutrition risk of intensive care unit patients. Malnutrition in critically ill patients with cirrhosis is a frequent but often overlooked complication with high prognostic relevance. This review article will discuss the substantial unmet medical need associated with HRS-AKI and the potential benefits if terlipressin was approved in the US. Terlipressin is a drug approved in Europe for treatment of HRS-AKI and supported by recommendations for first-line therapy by some liver societies and experts around the world. Improved therapeutic options to treat HRS-AKI are sought. The high mortality rate associated with HRS-AKI in the US is a reflection of the suboptimal standard of care. Renal replacement therapy is a temporary option but is known to confer an extremely poor, short-term prognosis in patients with HRS-AKI and, at best, serves as a bridge to liver transplantation for the minority of patients who are transplantation candidates. Liver transplantation is the ultimate solution but is only an option in a minority of patients since contraindications to transplantation are common and organ availability is limited. In the US, the mainstay of pharmacologic therapy consists of the off-label use of vasoconstrictive agents in combination with plasma expanders, a strategy that produces modest effects. However, interventions have limited efficacy, and mortality rates remain high. The goals of treatment are to reverse renal failure and prolong survival in critically ill patients. These data can be useful in the management of patients with HRS, particularly for patients who are candidates for liver transplantation.Īcute kidney injury in the setting of cirrhosis (hepatorenal syndrome-acute kidney injury ) is a severe and often fatal complication of end-stage liver disease. In conclusion, the outcome of patients with cirrhosis and HRS can be estimated by using two easily available variables, HRS type and MELD score. By contrast, the survival of patients with type 2 HRS was longer and dependent on MELD score (> or =20, median survival 3 mo <20, median survival 11 mo P <. All patients with type 1 HRS had a high MELD score (> or =20) and showed an extremely poor outcome (median survival: 1 mo). In a multivariate analysis of survival, only HRS type and MELD score were associated with an independent prognostic value. In the whole series, the median survival was 3.3 months. Patients with type 1 HRS not only had more severe liver and renal failure than type 2 patients, they also had greater impairment of circulatory function, as indicated by lower arterial pressure and higher activation of vasoconstrictor factors. Forty-one patients had type 1 HRS, while 64 patients had type 2 HRS. The study included 105 consecutive patients with HRS. The current study was designed to assess the prognostic factors and outcome of patients with cirrhosis and HRS. Moreover, the prognostic value of the model of end-stage liver disease (MELD) score has not been validated in the setting of HRS.
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However, scant information exists about factors predicting outcome in patients with cirrhosis and HRS. Important progress has been made recently regarding the pathogenesis and treatment of hepatorenal syndrome (HRS).