P-73 NORADRENALINE IN THE TREATMENT OF HEPATORENAL SYNDROME TYPE AKI: RESULTS IN NON-ICU HOSPITAL SETTING

Conflict of interest

No

Introduction and Objectives

Hepatorenal syndrome acute kidney injury (HRS-AKI) is a phenotype of acute kidney injury that occurs in patients with decompensated liver cirrhosis owing to circulatory dysfunction and systemic inflammation. To describe the clinical characteristics, treatment responses, and outcomes of patients who developed HRS-AKI in a non-ICU hospital setting.

Patients / Materials and Methods

Case series analysis. The electronic medical records were reviewed. Stata v18.0 was used for descriptive analysis.

Results and Discussion

Sixteen patients with cirrhosis admitted to a non-ICU hospital area who developed HRS-AKI were identified. The median age was 64.5 years (interquartile range [IQR]: 57-66.5). Sixty-eight percent had MASLD etiology. Seventy-five percent of patients were classified as CHILD C, with a median MELD-Na score of 26 points (IQR: 19-31). At the time of HRS-AKI diagnosis, the mean duration of prior intravenous albumin administration was 2.9 days.

All patients underwent central venous catheterization and hemodynamic monitoring. Eighty-eight percent (14) of the patients had resolved HRS-AKI, although two patients developed acute respiratory failure as a complication. The overall hospital mortality rate was 43.8% (n=7), HRS-AKI recurrence at 30 days was 35.7% (5/14), and time to recurrence was approximately 17 days.

Conclusions

HRS-AKI is a critical condition in patients with cirrhosis treated with vasopressors and intravenous albumin. In this case series, the use of norepinephrine outside the ICU proved to be effective and safe; however, the high recurrence and mortality rates suggest that it should be considered as a bridge therapy to liver transplantation.