Abstract: FR-PO0123
Early Relapse of Hepatorenal Syndrome
Session Information
- AKI: Epidemiology and Clinical Trials
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Shuaibi, Sameera Nadine, Ochsner Health, New Orleans, Louisiana, United States
- Punukollu, Pooja A., UQ-Ochsner Clinical School, New Orleans, Louisiana, United States
- Alsejari, Najat Yousef, Ochsner Health, New Orleans, Louisiana, United States
- Tobal, Ian, Ochsner Health, New Orleans, Louisiana, United States
- Chachad, Ravi, UQ-Ochsner Clinical School, New Orleans, Louisiana, United States
- Liberto, Rosemary, Ochsner Health, New Orleans, Louisiana, United States
- Mohamed, Muner, Ochsner Health, New Orleans, Louisiana, United States
- Wickman, Terrance Joseph, Ochsner Health, New Orleans, Louisiana, United States
- Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States
Group or Team Name
- Ochsner Nephrology.
Background
There is significant heterogeneity in the reported rates of relapse of hepatorenal syndrome (HRS). We aimed to examine the rate of relapse of HRS (relps-HRS) in a cohort of patients with cirrhosis and acute kidney injury (AKI) due to HRS who were optimally treated with a vasoconstrictor (VC) at a single center.
Methods
In a prospective observational cohort of AKI in cirrhosis, we searched for patients who met the ICA criteria for HRS, had a urinary sodium < 20 mEq/L, were treated with a VC [midodrine/octreotide (M/O), norepinephrine (NE) or terlipressin (T)], and achieved a minimum of 5 mmHg of rise in mean arterial pressure, over a 7-year period. Adjusted relps-HRS definition required fulfillment of these criteria: 1) ≥ 30% reduction in serum creatinine (sCr) within 7-10 days during the initial treatment, 2) new onset of a second AKI reaching to KDIGO stage 2 and occurring within 30 days of the first AKI, 3) being alive, not in hospice and without liver transplantation (LT) before the second AKI and within 30 days of the first AKI.
Results
Among 76 patients with HRS treated with a VC (58 NE, 14 T, 4 M/O) with available data (39% women, mean age 51, sCr 3.8 mg/dL, MELD 31.9), the overall rate of relps-HRS was 28.9% (22/76). 30-day mortality rate was 39% (40/76). ≥ 30% reduction in sCr during the initial treatment occurred in 49% (37/76). In 40 patients, relps-HRS was not assessable because: 13 (17%) patients underwent liver transplantation (LT) shortly after the first bout of HRS, 10 (13%) did not respond to the first round of VC, and 17 (22%) died or were discharged to hospice shortly after the first round of VC therapy. Thus, adjusted relps-HRS occurred in 22/36 (61%) of those in whom recurrence was assessable. Univariate and multivariate logistic regression analysis revealed that higher MELD score was associated with adjusted relps-HRS [33 vs 29, OR 1.173 (CI 1.008-1.364), p=0.039], but not age, sCr, or VC type.
Conclusion
30-day relps-HRS is common and associated with higher MELD score. This observation highlights the need for implementation of a durable VC therapy in HRS-AKI for those at high risk of relps-HRS.