Prognostic markers in patients with ascites and hepatorenal syndrome.

Cirrhosis is a progressive liver disorder characterized by a distorted liver architecture due to fibrosis which eventually leads to portal hypertension. It is a common cause of mortality accounting for over 26,000 deaths annually in the United States [1]. The natural course of patients with cirrhosis is frequently complicated by the accumulation of fluid in the peritoneal space in the form of ascites. This is caused by an abnormal regulation of extracellular fluid volume which leads to alterations in renal function with renal sodium retention, solute-free water retention, and renal vasoconstriction. These changes are responsible for fluid accumulation in the form of ascites, dilutional hyponatremia and hepatorenal syndrome (HRS) respectively. Ascites is the most common complication of cirrhosis and poses and increased risk for infections, renal failure and mortality. Patients with cirrhosis and ascites have a poor prognosis and it is estimated that nearly half of these individuals will die in approximately 5 years without liver transplantation. Hypervolemic hyponatremia and HRS occur later and confer an even a worse prognosis. This article reviews common prognostic markers and models in cirrhotic patients with ascites, hypervolemic hyponatremia and HRS.