Study of Clinical Profile and Outcome in Patients of Alcohol Induced Chronic Liver Disease with Hepato Renal Syndrome

Abstract

Background: Decompensated Chronic liver disease and cirrhosis are frequently complicated with renal dysfunction and this combination, called Hepato-Renal Syndrome (HRS) leads to significant morbidity and mortality. Acute renal dysfunction occurs in 15% to 25% of hospitalized patients with cirrhosis. The annual frequency of Hepato-renal syndrome(HRS) in cirrhotic patients with ascites is roughly 8% and, in some reports, as high as 40%.The observation that morbidity and mortality remain high once the syndrome is established has led to a focus on the prevention and early therapy of renal dysfunction in patients with cirrhosis. Hepato-renal syndrome (HRS) is a serious complication of liver cirrhosis with critically poor prognosis. Rapid diagnosis and management are important, since recent treatment modalities including vasoconstrictor therapy can improve short-term outcome and buy time for liver transplantation, which can result in complete recovery. Recognizing the trait about chronic alcoholism in a patient, counselling by doctor about avoidance of alcohol, & early recognition of progression to CLD by investigations may be helpful in preventing this complication. Aims and Objectives: To study clinical profile, assess the course and severity and outcome of patients admitted with alcohol induced chronic liver disease with hepato-renal syndrome. Methodology: A prospective (observational), hospital based study was carried out in 57 patients who met our inclusion criteria. Results: The study population's most common age group was between 36 and 45 years (33.3%), 46 to 55 years (24.6%), and more than 55 years (22.8%) with the mean age of 43 + 7.8 years amongst study population with a male predominanace (87.7%), Icterus and ascitis (100%) followed by Flapping tremors (98.25%), Oliguria (82.5%), Edema Feet (73.68%), Altered sensorium (66.7%) and Abdominal Distension (59.65%) were the commonest clinical features. History of alcohol intake for more than 10 years (61.4%) followed by less than 10 years (38.6%) and most of them were heavy drinkers (>4 drinks per day) (44.2%) while moderate and light drinkers (2-4 drinks/day and 1-2 drinks/day ) were 32.7% and 23.1% respectively. Previous history of admissions due to similar or related illness was observed in 78.9% of study population. Most of our patients had Type I HRS (75.4%) followed by Type II (24.53%). In our study, death was occurred in all patients with worsened hepatic and renal dysfunction (100%) and the difference was statistically significant. Conclusion: Hepato Renal Syndrome is a major decompensation in advanced alcohol induced liver cirrhosis with a high short-term mortality rate.