Researchers from Barcelona, Spain, assessed the incidence, clinical course, predictive factors, and prognosis of renal failure in patients with cirrhosis and gastrointestinal (GI) bleeding.
A total of 175 consecutive episodes of GI bleeding in 161 patients were analyzed.
Renal failure occurred in 20 (11%) episodes - it was transient in 8 episodes and nontransient in 12.
It was found to be more common in patients with cirrhosis, than in a control population of bleeding patients without cirrhosis, matched by age and severity of the bleeding episode.
Some 39 clinical and laboratory variables were obtained at admission or during hospitalization in each subject. These were related with the bleeding episode or with liver and renal function.
Of these, the presence of hypovolemic shock, number of packed red blood cells transfused, Child-Pugh class at admission, and baseline platelet count were independent predictors of renal failure.
|Mortality rate after GI bleeds:|
With renal failure 55%
Without renal failure 3%
The team found that the development of renal failure and hypovolemic shock were the only independent predictors of in-hospital mortality.
Mortality rate among the 20 episodes with renal failure was 55% (11 deaths), as compared with only 3% (5 deaths) in the 155 episodes without renal failure.
The development of nontransient renal failure entailed a much greater mortality, as compared with transient renal failure (10/12 [83%] vs 1/8 [12%]).
Author Andrés Cárdenas said on behalf of the group, "Renal failure is a common event in patients with cirrhosis and GI bleeding, the occurrence of which is mainly related to the severity of bleeding and baseline liver function."
"Renal failure is a strong predictor of mortality in patients with cirrhosis and GI bleeding," it was concluded.