{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T17:39:15Z","timestamp":1774028355564,"version":"3.50.1"},"reference-count":46,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T00:00:00Z","timestamp":1638144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hepatorenal syndrome (HRS) is a type of acute kidney injury (AKI), occurring in patients with decompensated liver cirrhosis and is associated with high mortality. We aim to describe the predictors associated with the development of HRS in cirrhotic patients with AKI. We retrospectively analyzed 529 cirrhotic patient encounters with AKI across all Northwell Health institutions between 1 January 2015 and 31 December 2018. We performed multivariate analyses to determine independent predictors of development of HRS. Alcoholic cirrhosis was the most common identified etiology of cirrhosis. The mean Model for End-Stage Liver Disease Scorewas18 (\u00b17). Ascites was the most commonly identified clinical feature of portal hypertension. Infection was identified in 38.4% of patients with urinary tract infection\/pyelonephritis being the most common. Spontaneous bacterial peritonitis occurred in 5.9% of patients. The most common cause of AKI was pre-renal. Hepatorenal syndrome was identified in 9.8% of patient encounters. Predictors of HRS were history of ascites, serum creatinine &gt;2.5 mg\/dL, albumin &lt;3 g\/dL, bilirubin &gt;2 mg\/dL and spontaneous bacterial peritonitis. We demonstrate strong predictors for the development of HRS which can aid clinicians to attain an early diagnosis of HRS, leading to prompt and targeted management and improving outcomes.<\/jats:p>","DOI":"10.3390\/jcm10235621","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T01:43:22Z","timestamp":1638323002000},"page":"5621","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Predictors of Development of Hepatorenal Syndrome in Hospitalized Cirrhotic Patients with Acute Kidney Injury"],"prefix":"10.3390","volume":"10","author":[{"given":"Roula","family":"Sasso","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Staten Island University Hospital\u2014Northwell Health, New York, NY 10305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Abou Yassine","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Staten Island University Hospital\u2014Northwell Health, New York, NY 10305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliane","family":"Deeb","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Staten Island University Hospital\u2014Northwell Health, New York, NY 10305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3350\/cmh.2014.20.2.185","article-title":"Prevalence of renal dysfunction in patients with cirrhosis according to ADQI-IAC working party proposal","volume":"20","author":"Choi","year":"2014","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5414\/CNP65028","article-title":"Incidence and factors predictive of acute renal failure in patients with advanced liver cirrhosis","volume":"65","author":"Wu","year":"2006","journal-title":"Clin. Nephrol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"195","DOI":"10.14218\/JCTH.2015.00015","article-title":"Acute Kidney Injury in Patients with Cirrhosis","volume":"3","author":"Russ","year":"2015","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"108139","DOI":"10.1155\/2015\/108139","article-title":"Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study","volume":"2015","author":"Allegretti","year":"2015","journal-title":"Int. J. Nephrol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1097\/MEG.0b013e328308bb9c","article-title":"Cirrhotics admitted to intensive care unit: The impact of acute renal failure on mortality","volume":"21","author":"Cholongitas","year":"2009","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1053\/j.gastro.2005.09.024","article-title":"Renal failure in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis: Value of MELD score","volume":"129","author":"Terra","year":"2005","journal-title":"Gastroenterology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.jhep.2019.07.002","article-title":"News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document","volume":"71","author":"Angeli","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"m2687","DOI":"10.1136\/bmj.m2687","article-title":"Hepatorenal syndrome: Pathophysiology, diagnosis, and management","volume":"370","author":"Simonetto","year":"2020","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1002\/hep.21920","article-title":"Model for end-stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure","volume":"46","author":"Thabut","year":"2007","journal-title":"Hepatology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"293","DOI":"10.4254\/wjh.v9.i6.293","article-title":"Hepatorenal syndrome: Update on diagnosis and therapy","volume":"9","author":"Acevedo","year":"2017","journal-title":"World J. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100236","DOI":"10.1016\/j.aohep.2020.07.008","article-title":"An Integrated Review of the Hepatorenal Syndrome","volume":"22","author":"Piano","year":"2021","journal-title":"Ann. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1097\/MEG.0000000000001462","article-title":"Management and outcomes of hepatorenal syndrome at an urban academic medical center: A retrospective study","volume":"31","author":"Bashir","year":"2019","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1002\/hep.25735","article-title":"Association of AKI with mortality and complications in hospitalized patients with cirrhosis","volume":"57","author":"Belcher","year":"2013","journal-title":"Hepatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1002\/hep.23283","article-title":"Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome","volume":"51","author":"Nazar","year":"2010","journal-title":"Hepatology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1038\/s41572-018-0022-7","article-title":"Hepatorenal syndrome","volume":"4","author":"Angeli","year":"2018","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1002\/lt.26072","article-title":"The Current Management of Hepatorenal Syndrome-Acute Kidney Injury in the United States and the Potential of Terlipressin","volume":"27","author":"Flamm","year":"2021","journal-title":"Liver Transpl."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e50","DOI":"10.1097\/MCG.0b013e3182688d2f","article-title":"Use of administrative claims data for identifying patients with cirrhosis","volume":"47","author":"Nehra","year":"2013","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1681\/ASN.2006010073","article-title":"Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure","volume":"17","author":"Waikar","year":"2006","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7223","DOI":"10.3748\/wjg.v20.i23.7223","article-title":"Comorbidity in cirrhosis","volume":"20","author":"Jepsen","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"c179","DOI":"10.1159\/000339789","article-title":"KDIGO clinical practice guidelines for acute kidney injury","volume":"120","author":"Khwaja","year":"2012","journal-title":"Nephron. Clin. Pract."},{"key":"ref_21","first-page":"85","article-title":"Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes","volume":"37","author":"Makris","year":"2016","journal-title":"Clin. Biochem. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e840","DOI":"10.1161\/CIR.0000000000000664","article-title":"Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association","volume":"139","author":"Rangaswami","year":"2019","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"23022","DOI":"10.1038\/srep23022","article-title":"Acute Kidney Injury Classification for Critically Ill Cirrhotic Patients: A Comparison of the KDIGO, AKIN, and RIFLE Classifications","volume":"6","author":"Pan","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/0016-5085(93)90031-7","article-title":"Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites","volume":"105","author":"Escorsell","year":"1993","journal-title":"Gastroenterology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"661","DOI":"10.5507\/bp.2015.010","article-title":"Predictors of hepatorenal syndrome in alcoholic liver cirrhosis","volume":"159","author":"Janicko","year":"2015","journal-title":"Biomed. Pap. Med. Fac. Univ. Palacky Olomouc Czechoslov."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Rey, R.M., Delgado, A.F., De Zubiria, A., Pinto, R., De la Hoz-Valle, J.A., P\u00e9rez-Riveros, E.D., Ardila, G., and Sierra-Arango, F. (2020). Prevalence and short-term outcome of hepatorenal syndrome: A 9-year experience in a high-complexity hospital in Colombia. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0239834"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1055\/s-0032-1330676","article-title":"Serum sodium identifies patients with cirrhosis at high risk of hepatorenal syndrome","volume":"51","author":"Abraldes","year":"2013","journal-title":"Z. Gastroenterol."},{"key":"ref_28","first-page":"220","article-title":"Hyponatremia and Hepatorenal Syndrome","volume":"11","author":"Mohanty","year":"2015","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0168-8278(88)80462-8","article-title":"Renin-angiotensin system in dogs following chronic bile-duct ligation. Relation to vascular reactivity","volume":"6","author":"Naveh","year":"1988","journal-title":"J. Hepatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1002\/hep.1840060408","article-title":"Systemic hypotension and decreased pressor response in dogs with chronic bile duct ligation","volume":"6","author":"Bomzon","year":"1986","journal-title":"Hepatology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1038\/ki.2013.78","article-title":"Bile cast nephropathy is a common pathologic finding for kidney injury associated with severe liver dysfunction","volume":"84","author":"Salem","year":"2013","journal-title":"Kidney Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1002\/hep.30499","article-title":"Cholemic Nephropathy Causes Acute Kidney Injury and Is Accompanied by Loss of Aquaporin 2 in Collecting Ducts","volume":"69","author":"Mederacke","year":"2019","journal-title":"Hepatology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1002\/hep.510230122","article-title":"Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club","volume":"23","author":"Arroyo","year":"1996","journal-title":"Hepatology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1001\/archinte.1994.00420020117013","article-title":"Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis","volume":"154","author":"Caregaro","year":"1994","journal-title":"Arch. Int. Med."},{"key":"ref_35","first-page":"1168","article-title":"Cystatin C is a good predictor of hepatorenal syndrome and survival in patients with cirrhosis who have normal serum creatinine levels","volume":"59","author":"Ahn","year":"2012","journal-title":"Hepato-Gastroenterol."},{"key":"ref_36","first-page":"131","article-title":"Serum cystatin C in advanced liver cirrhosis and different stages of the hepatorenal syndrome","volume":"12","author":"Barakat","year":"2011","journal-title":"Arab J. Gastroenterol. Off. Publ. Pan-Arab Assoc. Gastroenterol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1002\/hep.1840200619","article-title":"Renal impairment after spontaneous bacterial peritonitis in cirrhosis: Incidence, clinical course, predictive factors and prognosis","volume":"20","author":"Follo","year":"1994","journal-title":"Hepatology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1002\/hep.26687","article-title":"Type-1 hepatorenal syndrome associated with infections in cirrhosis: Natural history, outcome of kidney function, and survival","volume":"59","author":"Barreto","year":"2014","journal-title":"Hepatology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1002\/hep.510270507","article-title":"Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: Relationship with the development of renal impairment and mortality","volume":"27","author":"Navasa","year":"1998","journal-title":"Hepatology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1016\/0016-5085(93)90361-F","article-title":"Tumor necrosis factor alpha and interleukin 6 plasma levels in infected cirrhotic patients","volume":"104","author":"Byl","year":"1993","journal-title":"Gastroenterology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1053\/j.gastro.2007.06.065","article-title":"Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis","volume":"133","author":"Navasa","year":"2007","journal-title":"Gastroenterology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1097\/MCG.0b013e31829006bb","article-title":"Decompensated cirrhotics have slower intestinal transit times as compared with compensated cirrhotics and healthy controls","volume":"47","author":"Ciarleglio","year":"2013","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Propst-Graham, K.L., Preheim, L.C., Vander Top, E.A., Snitily, M.U., and Gentry-Nielsen, M.J. (2007). Cirrhosis-induced defects in innate pulmonary defenses against Streptococcus pneumoniae. BMC Microbiol., 7.","DOI":"10.1186\/1471-2180-7-94"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5556354","DOI":"10.1155\/2021\/5556354","article-title":"NAFLD and Infection, a Nuanced Relationship","volume":"2021","author":"Adenote","year":"2021","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_45","first-page":"1246","article-title":"Characterization of inflammatory response in hepatorenal syndrome: Relationship with kidney outcome and survival","volume":"39","author":"Huelin","year":"2019","journal-title":"Liver Int. Off. J. Int. Assoc. Study Liver"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/17474124.2020.1708190","article-title":"Diagnosis and management of renal dysfunction in patients with cirrhosis","volume":"14","author":"Carrion","year":"2020","journal-title":"Expert Rev. Gastroenterol. Hepatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/23\/5621\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:37:15Z","timestamp":1760168235000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/23\/5621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,29]]},"references-count":46,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["jcm10235621"],"URL":"https:\/\/doi.org\/10.3390\/jcm10235621","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,29]]}}}