Platelet/Albumin Ratio, Fractional Excretion of Sodium, and Glomerular Filtration Rate as Novel Predictors for Hepatorenal Syndrome in Patients with Liver Cirrhosis

Background and study aim: Hepatorenal Syndrome acute kidney injury (HRS-AKI) is an emergency complication occurring exclusively in patients with advanced liver cirrhosis (LC) and ascites, and a well-timed diagnosis is optimal. The KDIGO guidelines recently pointed out that HRS-AKI and terlipressin administration should not be postponed for 48 hours previously dictated as obligatory for exclusion of pre-renal azotemia. This study assessed the significance of certain albumin-related ratios, fractional excretion of sodium (FeNa), and estimated glomerular filtration rate (eGFR) and established a related equation that could predict the development of HRS-AKI in patients with LC.Patients and Methods: The study design is cross sectional including 122 participants. Group 1: HRS (n=34), group 2: pre-renal azotemia (n=34), group 3: LC without renal impairment (n=36), while group 4: healthy controls (n=18). Certain albumin-related ratios, eGFR, Model of End Stage Disease (MELD), FeNa as well as the Child Pugh score were calculated. Receiver operating characteristic (ROC) curve analysis in addition to multivariate logistic regression were performed to identify the independent predictors of HRS.Results: A multivariate logistic regression analysis identified platelets/albumin ratio, albumin-platelets product, eGFR and FeNa as independent predictors for HRS in patients with LC. Moreover, a predictive equation was derived showing that the probability of HRS = 1/ (1+e^-10.191 + 0.037 (platelet/albumin ratio) + 0.112 (GFR)+4.044 (albumin-platelets product) +4.73 (FeNa)), with a diagnostic sensitivity, specificity and accuracy of 85%, 83% and 83% respectively. Conclusion: A multivariate logistic regression analysis identified platelets/albumin ratio, albumin-platelets product, eGFR and FeNa as independent predictors for HRS in patients with LC. Moreover, a predictive equation was derived showing that the probability of HRS = 1/ (1+e^-10.191 + 0.037 (platelet/albumin ratio) + 0.112 (GFR)+4.044 (albumin-platelets product) +4.73 (FeNa)), with a diagnostic sensitivity, specificity and accuracy of 85%, 83% and 83% respectively.