Renal failure after upper gastrointestinal bleeding in cirrhosis: Incidence, clinical course, predictive factors, and short-term prognosis

Authors

  • Andrés Cárdenas,

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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  • Pere Ginès,

    Corresponding author
    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
    • Liver Unit, Hospital Clínic, Villaroel 170, 08036 Barcelona, Spain. fax: (34) 93-451-5522
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  • Juan Uriz,

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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  • Xavier Bessa,

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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  • Joan Manuel Salmerón,

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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  • Antoni Mas,

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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  • Rolando Ortega,

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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  • Blas Calahorra,

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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  • Dara De Las Heras,

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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  • Jaime Bosch M.D.,

    Corresponding author
    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
    • Liver Unit, Hospital Clínic, Villaroel 170, 08036 Barcelona, Spain. fax: (34) 93-451-5522
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  • Vicente Arroyo,

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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  • Juan Rodés

    1. Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona; Institut d'Investigacions Biomédiques August Pi-Sunyer (IDIBAPS); Instituto Reina Sofia de Investigación Nefrológica, Barcelona, Catalunya, Spain.
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Abstract

To assess the incidence, clinical course, predictive factors, and prognosis of renal failure in patients with cirrhosis and gastrointestinal bleeding, 175 consecutive episodes of gastrointestinal bleeding in 161 patients were analyzed. Renal failure occurred in 20 (11%) episodes and was transient in 8 episodes and nontransient in 12. Renal failure was 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. Among 39 clinical and laboratory variables obtained at admission or during hospitalization related with the bleeding episode or with liver and renal function, 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. The development of renal failure and hypovolemic shock was 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 (P < .01). The development of nontransient renal failure entailed a much greater mortality as compared with transient renal failure (10 of 12 [83%] vs. 1 of 8 [12%]; P < .01). In conclusion, renal failure is a common event in patients with cirrhosis and gastrointestinal 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 gastrointestinal bleeding.

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