DOI: https://doi.org/10.53350/pjmhs22168410 ORIGINAL ARTICLE 410 P J M H S Vol. 16, No. 08, August 2022 Frequency and Outcomes of Hepatorenal Syndrome in Patients with Chronic Liver Disease SARWAR KHAN 1 , KAPEEL RAJA 2 , MUZZAMIL RIAZ MALIK 3 , SOHAIL HUSSAIN 4 , KHALIL UR REHMAN 5 , HIRA TAHIR 6 1 MBBS, FCPS, (Gastroenterology), THQ Hospital Dargai Malakand 2 Associate Professor Department of Gastroenterology, Hepatology & Nutrition, Pir Abdul Qadir Shah Jilani Institute Of Medical Science Gambat Khairpur, Sindh Pakistan (Formerly known as Gambat institute of Medical Science Gambat) 3 Assistant Professor Department of Nephrology Sargodha Medical College Sargodha, Punjab 4 Assistant Professor, Consultant Gastroenterologist and Hepatologist, Clinical Cordinator for Postgraduate studies, Ziauddin University Karachi 5 House Officer, Deptt of Internal Medicine, Bolan Medical Complex Quetta 6 Medical Graduate, Sheikh Zayed Medical college, Rahim yar khan Corresponding author: Muzzamil Riaz Malik, Email : dr.muzzamil@gmail.com ABSTRACT Objective: To determine the frequency of hepatorenal syndrome in patients presented with chronic liver disease, also examine one month mortality in patients diagnosed with hepatorenal syndrome. Study Design: Prospective/Observation Study Place and Duration: Medical Ward, THQ Hospital Dargai Malakand and Ziauddin University Karachi, From November, 2021 to April, 2022. Methodology: One hundred and five patients of either gender presented with chronic liver disease having ages 18 to 65 years were enrolled. Detailed demographics including age, sex, BMI, duration of disease and etiology of liver cirrhosis were recorded after taking informed written consent. Patients with hepatic encephalopathy being treated with nephrotoxic drugs, acute infection, hypovolemia, sepsis, and fulminant and sub-fulminant hepatic failure were excluded. Serum creatinine was analyzed in all the patients to examine renal failure. Outcomes in term of one month mortality was also examined in HRS patients. Data was analyzed by SPSS 24.0. Results: There were 63 (60%) males while 42 (40%) patients were females with mean age 47.18±11.64 years. Mean BMI was 24.66±3.84 kg/m 2 . Among 105 patients 15 (14.29%) patients were diagnosed to have hepatorenal syndrome. Out of 15 HRS patients, 4 (26.67%) were died. Conclusion: It is concluded that frequency of hepatorenal syndrome in liver cirrhosis patients was high. And HRS was associated with high rate of mortality. Keywords: Chronic Liver Disease, HBV, HCV, Hepatorenal Syndrome, Mortality INTRODUCTION Cirrhosis, which is the last stage of hepatocellular injury, can lead to malfunction and even failure of the liver. The condition known as cirrhosis of the liver worsens with time. This degenerative illness, for which there is now no treatment, is characterised by the development of fibrosis and nodular regrowth. This illness is currently the top cause of death around the globe [1]. Despite the fact that hepatitis B and C are responsible for roughly 65 percent of cirrhosis cases in Pakistan, it is simple to avoid contracting any of these viruses by participating in routine community health care [2]. A sizeable percentage of Pakistan's people suffer from the liver disease cirrhosis. Cirrhosis is linked to a high mortality rate, which may be explained by the numerous life-threatening consequences that can develop as a result of the condition. Diseases such as hepatic encephalopathy, gastrointestinal haemorrhage, hepatopulmonary syndrome, and hepatoreticular syndrome are included in this group. Hepatorenal syndrome (HRS) [3, 4] is a disorder in which patients who have liver failure (acute or chronic) also have a steady decline in their kidney function over time. Patients who have this condition are considered to have hepatorenal syndrome. Researchers Anand and colleagues [4] discovered that therapy with nonsteroidal anti-inflammatory drugs led to a reduction in renal blood flow as well as the glomerular filtration rate in cirrhotic patients who had ascites (GFR). Additional research conducted over the subsequent two decades confirmed that renal failure was brought on by a combination of renal circulation vasoconstriction and severe systemic arteriolar vasodilatation. [Citation needed] [Citation needed] [Citation needed] [Citation needed] Because of the interaction between these two systems, there was a reduction in the systemic vascular resistance, which led to a drop in blood pressure [5]. In accordance with the degree of impairment it causes, hepatorenal syndrome can be divided into types 1 and 2. A characteristic feature of type 2 HRS, which results in modest renal impairment, is ascites that is unresponsive to treatment with diuretics. Patients who have type 2 HRS have initial blood creatinine levels that are lower than 2.5 mg/dL7, which is indicative of having 50 percent renal function. Patients diagnosed with type 2 HRS have a median survival time of six months [6-7], and the progression of the disease is gradual and consistent. It has been connected to the progression of cirrhosis. The transition from Type 2 to Type 1 HRS is characterised by a rapid loss in acute renal function and an inability to maintain adequate perfusion of the kidneys [8-9]. People who have type 1 diabetes typically have a glomerular filtration rate (GFR) that is lower than 20 mL/min and a rapid rise in blood creatinine levels (more than 2.5 mg/dL in 2 weeks). The disease is associated with a high death rate; the usual amount of time someone lives after receiving a diagnosis is just 8- 12 weeks8, and the probability of survival beyond 30 days reduces to 25% [10, 11]. At least forty percent of people who have cirrhosis will develop hepatorenal syndrome at some point over the course of the disease. In fewer than 5% of instances, it can be undone by itself on its own. Hepatorenal syndrome is responsible for more than half of all deaths that are associated with cirrhosis [12]. This study was carried out to determine the frequency of occurrence of hepatorenal syndrome (HRS) in patients with chronic liver disease as well as the short-term repercussions that accompany its presence. MATERIALS AND METHODS This prospective/observational study was conducted at Medical Ward, THQ Hospital Dargai Malakand and Ziauddin University Karachi, during from the period November, 2021 to April, 2022. Total 105 patients of either gender presented with chronic liver disease having ages 18 to 65 years were enrolled. After receiving the participants' given written consent, detailed demographic information was gathered. This information included the participants' ages, genders, body mass indexes, duration of disease, and the causes of liver cirrhosis. Patients who had hepatic encephalopathy and were receiving treatment with nephrotoxic medicines were not eligible for the study. Neither were