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

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 patien ts with cirrhosis than in a control population of bleeding patients without cirrhosis matched by age and severity of the bleeding episode. Among 39 cl inical and laboratory variables obtained at admission or during hospitaliza tion related with the bleeding episode or with liver and renal function, th e presence of hypovolemic shock, number of packed red blood cells transfuse d, Child-Pugh class at admission, and baseline platelet count were independ ent predictors of renal failure. The development of renal failure and hypov olemic 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 fail ure (P < .01). The development of nontransient renal failure entailed a muc h 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 even t in patients with cirrhosis and gastrointestinal bleeding, the occurrence of which is mainly related to the severity of bleeding and baseline liver f unction. Renal failure is a strong predictor of mortality in patients with cirrhosis and gastrointestinal bleeding.