Low sodium urine concentration is associated with poor survival in patients with HRS

Background and Objectives: Terlipressin plus albumin therapy for hepatorenal syndrome (HRS) has become an accepted and effective regimen. However, only 50% to 60% of the patients respond to the treatment. Since this therapy is associated with high cost and risk for adverse effects, more accurate predictors for response to therapy are warranted. Therefore we checked i) the response to therapy on the basis of clinical or etiological parameters before treatment ii) the short- and long-term survival and iii) the correlation between treatment response and overall mortality. Methods: A retrospective evaluation of 21 patients (13m/8f) with HRS1 was performed. Four of the 21 patients were transplanted after treatment with terlipressin plus albumin. Terlipressin was administered by continuous intravenous infusion and albumin by short-time infusion. Success of the treatment was defined by a decrease in serum creatinine level to ≤ 1.5mg/dL or by a ≥ 50% reduction of the baseline concentration. Results: 57% of the patients responded to treatment, which was significantly associated with survival at day 60 compared to non-responders. However, the overall mortality was not significantly different between the two groups. High age was a significantly negative predictor for therapy response. Furthermore, baseline urinary level of sodium turned out to be prognostic for survival. The MELD score did not correlate with response to therapy. Conclusions: Terlipressin plus albumin treatment provides a significant two-months survival advantage for therapy responders. Higher age is a predictor of non-response. Prognosis of survival chances should include the baseline urinary sodium concentration.