Prevalence and Determinants of Hepatorenal Syndrome among Adults with Decompensated Advanced Chronic Liver Disease admitted at Muhimbili National Hospital, Dar Es Salaam, Tanzania

Prevalence and Determinants of Hepatorenal Syndrome among Adults with Decompensated Advanced Chronic Liver Disease admitted at Muhimbili National Hospital, Dar Es Salaam, Tanzania | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Determinants of Hepatorenal Syndrome among Adults with Decompensated Advanced Chronic Liver Disease admitted at Muhimbili National Hospital, Dar Es Salaam, Tanzania Joshua Karaba, Jonhas Masatu, David Osima, Abdallah Njate, Abbas Godian, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8778470/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Hepatorenal syndrome (HRS) is a severe complication of Decompensated Advanced Chronic Liver Disease (dACLD) with more than 80% mortality when not well treated. There is no published Tanzanian evidence on its prevalence and determinants. Therefore, this study aimed to assess the prevalence and determinants of hepatorenal syndrome among adults with dACLD admitted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. Methods We conducted a hospital‑based cross-sectional study over six months (August 2024 to January 2025) among 100 consecutively enrolled adults with dACLD at MNH. Data on sociodemographic, clinical, and laboratory characteristics were collected. HRS was diagnosed using International Ascites Club (2015/2021) criteria. Stata 15 was used to analyze the data, and multivariable Poisson regression with robust standard errors was used to assess the determinants of HRS, where variables with a bivariable p-value ≤ 0.2 at 95% Confidence Interval (CI) were taken to multivariable, and the significance was measured at the p-value ≤ 0.05 at 95% CI. Results The prevalence of HRS was 11.0% (95% CI 5.0–18.0). The determinants of HRS were hyponatremia (serum sodium < 125 mmol/L) and hypoalbuminemia (serum albumin < 2.5 g/dL), which were independently associated with HRS (aPR 3.95, 95% CI 1.36–11.51; and aPR 4.94, 95% CI 1.20–20.28, respectively). However, other clinical factors, including upper gastrointestinal bleeding and higher Model for End-Stage Liver Disease (MELD) category, showed positive association but were not statistically significant. Conclusion The prevalence of HRS among dACLD patients at MNH was 11.0%, whereby hyponatremia and hypoalbuminemia were the key determinants. This underscores the need for routine monitoring of sodium and albumin to flag high‑risk patients, and timely access to supportive therapies should be prioritized. Prevalence Determinants Hepatorenal Syndrome Decompensated Advanced Chronic Liver Disease Tanzania Figures Figure 1 Figure 2 Introduction HRS is a functional kidney failure that occurs in patients with advanced portal hypertension and systemic circulatory dysfunction in the absence of intrinsic kidney disease(Progress & Schrier, 2009 ; Kerrigan et al., 2019 ). It is one of the most severe complications of dACLD and is associated with poor prognosis and high short-term mortality(Sodium, 2015 ; Kerrigan et al., 2019 ). Studies show that its pathophysiology involves splanchnic vasodilatation, arterial underfilling, and renal vasoconstriction, which ultimately reduce renal perfusion(Simonetto et al., 202;Roozbeh et al., 2024 ). Globally, the prevalence of HRS among dACLD ranges between 7.9% and 23.9%, depending on patient characteristics and diagnostic criteria(Roozbeh et al., 2024 ;Lalaina et al., 2021 ;Pose et al., 2024 ;Thapa et al., 2020 ). However, Pakistan, Madagascar, and most of the Asian countries reported HRS prevalences of 11.9% and 7.9%, respectively. On the other hand, Colombia reported rates up to 23.9%(Guidelines, 201;Pose et al., 2024 ).The HRS typically occurs commonly among dACLD patients and is often triggered by precipitating events such as Spontaneous Bacterial Peritonitis (SBP), gastrointestinal bleeding, or large-volume paracentesis without albumin support (Seshadri et al., 2022 ;Tiwari et al., 2025 ;. The evolution of diagnostic criteria by the International Ascites Club (IAC) in 2015 and 2021 has improved recognition of early HRS-Acute Kidney Injury (HRS-AKI), allowing earlier treatment (Progress & Schrier, 200;Ali et al., 2023 ;Sendra, 2018 ). Despite the fact that determinants of HRS have been identified including hyponatremia, hypoalbuminemia, bilirubin, and high Model for End-Stage Liver Disease (MELD) scores there are regional variations due to genetic and healthcare differences (Adebayo & Wong, 2023 ;Lenz et al., 2015 ;Simonetto et al., 2020 ). Data from sub-Saharan Africa remain scarce; to date, only one study from Madagascar has reported HRS prevalence(Roozbeh et al., 2024 ). No similar data exist from Tanzania, despite the increasing burden of chronic liver disease and admissions due to dACLD(Ayal et al., 2025 ; Plan et al., 2022 ). Understanding the magnitude and predictors of HRS is crucial for early diagnosis, timely management, and rational allocation of limited resources such as albumin and vasoconstrictor therapies(MoH, 2018;Amico et al., 2006 );Fida et al., 2020 ). This study aimed to assess the prevalence and determinants of hepatorenal syndrome among adults with dACLD admitted at MNH, Dar es Salaam, Tanzania. Methods Study design and setting We conducted a hospital‑based cross-sectional study at MNH, Dar es Salaam, Tanzania, from August 2024 to January 2025. The MNH is a government-owned tertiary hospital located in Upanga, Dar es Salaam, Tanzania. MNH has a National Reference Laboratory and Central Pathology Laboratory (CPL); it serves as a teaching entity for various health specialties and superspecialists and serves a population exceeding 4 million people. It has about a 1500-bed capacity and attends to about 1000 outpatients and 1000 inpatients per week. MNH has a total of over 20 certified adult gastroenterologists allocated in the gastro-hepatology subunit that serves as a National Referral Point for gastroenterology- and hepatology-related cases from different referral hospitals throughout Tanzania and other East African countries. The unit manages patients with dACLD. Therefore, make it a suitable study setting for this study. Sampling and study population We employed a consecutive sampling technique involving selecting every patient admitted with dACLD who meets the inclusion criteria until the sample size of 100 patients was attained. We included dACLD patients aged 18 years and above; however, we excluded dACLD patients, patients with preexisting renal disease, and patients who had undergone renal transplantation. Sample size calculations The sample size for this study was estimated using the Kish Leslie formula for cross-sectional studies, with finite population correction. The formula given is: $$\:n=Nx\frac{\frac{{z}^{2}.p(1-p)}{{e}^{2}}}{[N-1+\left(\frac{{z}^{2}.p\left(1-p\right)}{{e}^{2}}\right)]}$$ Where \(\:n\) = minimum sample size required Z = Z-score for 95% confidence interval which is 1.96 e= Margin of error set at 5% (0.05) N= Total number of decompensated advanced chronic liver disease patients expected to be available during the study period. Based on hospital records, approximately 30 patients with decompensated cirrhosis were admitted monthly at MNH, giving an estimated population of 180 patients over six-month recruitment period (N = 180). \(\:p\) is the estimated prevalence of HRS. A prevalence of 11.9% ( p = 0.119) was adopted from a study in Pakistan(Ali et al., 2023 ) \(\:n\) = 84/0.90 (Taking into consideration 10% non-response rate) Therefore, the estimated sample size was 100. Variables Dependent variable The dependent variable was HRS, which was diagnosed following the International Ascites Club (2015/2021) criteria and measured as hyponatremia: serum sodium < 125 mmol/L; hypoalbuminemia: serum albumin < 2.5 g/dL. Shock: SBP < 90 mmHg or MAP < 70 mmHg with hypoperfusion and categorized as Yes or No as shown in Fig. 2 . Independent variables Independent variables were sociodemographic (age range and sex); Laboratory Parameters; (level of hemoglobin, count of platelets, level of serum sodium, level of potassium, level of serum albumin, total bilirubin, Blood Urea Nitrogen (BUN), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), International Normalized Ratio (INR), and Human Immunodeficiency Virus (HIV) status, hepatitis B status, and status of hepatitis C). Clinical features: a fever, jaundice, splenomegaly, oedema in the lower limbs, bleeding in the upper gastrointestinal tract (UGIB), ascites, grade of hepatic encephalopathy, spontaneous bacterial peritonitis, Child-Pugh class and MELD category of risk. As well as Risk factors; Drinking alcohol and Infection with schistosomiasis. The conceptual frame work of study variables are summarized in Fig. 1 . Data collection We used the standardized questionnaires to collect sociodemographic data, laboratory investigations, clinical findings and risk factors. The data was collected by trained Medical Doctors who were working at the Internal Medicine wards at MNH. They have two days of training on data collection tools, ethical issues and sampling procedures. Statistical Analysis Data collected was entered in Microsoft Excel and analyzed using STATA version 15. Descriptive statistics summarized characteristics using proportion, and the continuous variables were categorized using median and interquartile range. The determinants of HRS were first explored using bivariate analyses whereby variables with p ≤ 0.20 or clinical relevance were entered into a multivariable robust modified Poisson regression model to estimate adjusted prevalence ratios (aPR) with a p-value ≤ 0.05 and at 95% CI. Ethical considerations Ethical approval was obtained from the MUHAS Institutional Review Board with certificate number Ref. No. MNH/TRCU/PERM/2024/348. Permission to conduct the study was granted by MNH management with reference letter Ref. No. MNH/TRCU/PERM/2024/348. Written informed consent was obtained from all participants. Confidentiality was ensured through anonymized identification numbers and secure data handling. On the other hand, all patients found with HRS or other diagnoses were managed by adhering to local and international hospital protocols; the investigators did not interfere with care. Results Participant characteristics A total of 100 adults with dACLD were enrolled between August 2024 and January 2025. Of these, 69% were male, and the median age was 46 years (interquartile range 37-58.5) as summarized in Table 1 . Table 1 Social demographics of study Participant characteristics (N = 100) Social demographics variables Frequencies(N = 100) Percentages (%) Age Median Age = 46.0 IQR [37-58.5] ≤ 40 32 32.0 41–50 27 27.0 > 50 41 41.0 Sex Female 31 31.0 Male 69 69.0 Total 100 100 Clinical features Most patients presented with ascites (91%), jaundice (80%), and peripheral oedema (78%), while 22% had hepatic encephalopathy at admission. The leading etiologies of liver disease were chronic viral hepatitis B (39%), other Clinical features are summarized in Table 2 . Table 2 Clinical features of study participant characteristics (N = 100) CLINICAL FEATURES FREQUENCIES(N = 100) PERCENTAGES (%) Fever No 47 47.0 Yes 53 53.0 Jaundice No 11 11.0 Yes 89 89.0 Splenomegaly No 59 59.0 Yes 41 41.0 Lower limb edema No 34 34.0 Yes 66 66.0 UGIB No 52 52.0 Yes 48 48.0 Ascites Clinically diagnosed 1 1.0 Diagnosed by USS 99 99.0 HE Grade I 6 6.0 Grade II 11 11.0 Grade III 4 4.0 Grade IV 1 1.0 No hepatic Encephalopathy 78 78.0 SBP No 86 86.0 Yes 14 14.0 CTP class Class B 42 42 .0 Class C 55 55 .0 Class A 3 3.0 MELD score Extremely high risk 1 1.0 High risk 29 29.0 Low risk 4 4.0 Moderate risk 37 37.0 Very high risk 29 29.0 TOTAL 100 100 Laboratory Parameters In term of Laboratory evaluation showed a mean serum sodium of 127 ± 6mmol/l, mean albumin 2.7 ± 0.6 g/dL, and median total bilirubin 3.1 mg/dL (IQR 1.8–6.2). Overall, 32% of participants had hyponatremia (< 125 mmol/L) and 49% had hypoalbuminemia (< 2.5 g/dL). However, Child-Pugh classification found that 65% were in Class C and 35%, Class B, other Laboratory Parameters are shown in Table 3 . Table 3 Laboratory Parameters of study participant characteristics (N = 100) LABORATORY PARAMETERS FREQUENCIES(N = 100) PERCENTAGE (%) Hb level (g/dl) Low 78 78.0 Normal 22 22.0 Platelet count (x103/l) High 7 7.0 Low 64 64.0 Normal 29 29.0 Sodium level Greater or equal to 125 68 68.0 Less than 125 32 32.0 Potassium level Hyperkalemia 17 17.0 Hypokalemia 25 25.0 Normal 58 58.0 Serum Albumin levels Less than 2.5 49 49.0 Greater or equal to 2.5 51 51.0 Total Bilirubin level Elevated 85 85.0 Normal 15 15.0 BUN (mmol/l) Critically high 1 1.0 Elevated 41 41.0 Low 10 10.0 Normal 48 48.0 ALT Mild elevation 38 38.0 Moderate elevation 38 38.0 Severe elevation 6 6.0 Within normal range 18 18.0 AST Below normal range 1 1.0 Mild elevation 44 44.0 Moderate elevation 26 26.0 Severe elevation 15 15.0 Within normal range 14 14.0 INR Normal 28 28.0 Prolonged (mild) 53 53.0 Prolonged (moderate) 19 19.0 HIV No 85 85.0 Yes 15 15.0 Hepatitis B No 34 34.0 Yes 66 66.0 Hepatitis C No 96 96.0 Yes 4 4.0 TOTAL 100 100 Risk factors for HRS among adults’ patients with dACLD admitted at MNH Our study found that 49% of participants use alcohol, and 13.0% have a history of Schistosomiasis infection as the risk factor for HRS shown in Table 4 . Table 4 Risk factors for HRS among adults’ patients with dACLD admitted at MNH (N = 100) RISK FACTORS FREQUENCIES (N = 100) PERCENTAGES (%) Alcohol consumption No 51 51.0 Yes 49 49.0 Schistosomiasis infection No 87 87.0 Yes 13 13.0 TOTAL 100 100 Prevalence of HRS among adults’ patients with dACLD admitted at MNH Using the International Ascites Club 2015/2021 criteria, our study found 11% with CI (85% CI 5.0–18.0) at 95% prevalence of HRS among 100 adults’ patients with dACLD admitted at MNH. Determinants of HRS among Adults patients dACLD admitted at MNH After adjustment for confounders, Our study found that, hyponatremia and hypoalbuminemia determinants of HRS among adults’ patients with dACLD admitted at MNH, where by patients with Hyponatremia was 3.95 more likely to have HRS compared to one with no hyponatremia (aPR 3.95; 95% CI 1.36–11.51; p = 0.012), and patients with hypoalbuminemia were 4.94 more like to have HRS compare to one with no hypoalbuminemia (aPR 4.94; 95% CI 1.20–20.28; p = 0.027). However, the patients with UGIB were 2.11 more likely to have HSR compared to one with no UGIB (aPR 2.11; 95% CI 0.71–6.24; p = 0.18), but its association was not statistically significant. In another MELD category and bilirubin did not show any association with HRS. The results are summarized in Table 5 . Table 5 Multivariable analysis of the Determinants of HRS among Adults patients dACLD admitted at MNH Variable HRS n (%) cPR (95%CI) p-value aPR(95%CI) P-value Sodium level (mmol/l) Greater or equal to 125 4 (5.9) Ref Ref Less than 125 7 (21.9) 3.72 (1.17–11.86) 0.027 3.95 (1.36–11.51) 0.012 Serum Albumin levels (g/dl) Less than 2.5 9 (18.4) 4.88 (1.10–21.60) 0.037 4.94 (1.20-20.28) 0.027 Greater or equal to 2.5 2 (3.9) Ref Ref UGIB No 3 (5.8) Ref Ref Yes 8 (16.7) 2.89 (2.89-0.81-10.33) 0.103 274 (0.80–9.36) 0.107 cPR =crude Prevalence Ratio, aPR =adjusted Prevalence Ratio Discussion The prevalence of HRS among dACLD patients at MNH was very low whereby hyponatremia and hypoalbuminemia were the key determinants. The observed prevalence of 11% is comparable to that reported in Pakistan (11.9%) and slightly higher than Madagascar (11.9%) and slightly higher than Madagascar (7.9%), but lower than findings from Colombia (23.9%)(Roozbeh et al., 2024 ;Lalaina et al., 2021 ;Pose et al., 2024 ). These variations likely reflect differences in disease etiology, severity at presentation and diagnostic thresholds applied across regions(Thapa et al., 2020 ;Simonetto et al., 2020 ). Hyponatremia and hypoalbuminemia are the determinants of HRS, consistent with findings from other international studies(Adebayo & Wong, 2023 ;Lenz et al., 2015 (Wong et al., n.d.). This is due to the fact that hyponatremia indicates severe circulatory dysfunction due to arterial underfilling and activation of vasoconstrictor systems, which contributes directly to renal hypoperfusion(Adebayo & Wong, 202;Lenz et al., 2015 ). Hypoalbuminemia, on the other hand, reflects impaired hepatic synthetic function and worsened oncotic pressure, further compromising effective circulating volume and renal perfusion(Simonetto et al., 2020 ;Salerno et al., 2007 ). Our study found that MELD is not the determinant of HRS among dACLD patients. This is contrary to previous studies which showed MELD score and bilirubin levels increase the risk for HRS(Arroyo et al., 2008 (Salerno et al., 2007 );Patidar et al., 2024 ). These differences may be due to the small sample size in our study as well as the study design we employed or the dominant influence of sodium and albumin abnormalities in the Tanzanian patients. The findings from our study underscore the importance of early biochemical screening in patients with dACLD. Identifying hyponatremia and hypoalbuminemia can help clinicians initiate preventive measures and priorities high-risk patients for albumin supplementation or vasoconstrictor therapy(Wong et al., 2020;Liu et al., 2021 ;Progress & Schrier, 2009 ). Despite limitations, this study bridges a major local knowledge gap by providing baseline Tanzanian data on HRS. It reinforces the clinical relevance of sodium and albumin as prognostic markers and supports resource prioritization for early diagnosis and supportive treatment in dACLD (Patidar et al., 202;Ayal et al., 2025 ;Plan et al., 2022 ). Conclusion and Recommendations Conclusion The prevalence of HRS among dACLD patients at MNH was very low whereby hyponatremia and hypoalbuminemia were the key determinants. Recommendations We recommend the following to the tertiary hospitals, Ministry of Health and healthcare providers to: Health care providers to ensure routinely monitor serum sodium and albumin in all patients with dACLD and initiate early supportive care where abnormalities are detected. Hospitals management, and Ministry of Health to ensure the availability of albumin and vasoconstrictor therapy and develop context-appropriate diagnostic algorithms. To conduct Further research should explore cost-effective preventive strategies and long-term outcomes to improve prognosis in Tanzanian patients with advanced liver disease. Abbreviations AI Artificial Intelligence ALT Alanine Aminotransferase APR Adjusted Prevalence Ratio AST Aspartate Aminotransferase BUN Blood Urea Nitrogen CI Confidence Interval CPL Central Pathology Laboratory CRP Crude Prevalence Ratio dACLD Decompensated Advanced Chronic Liver Disease HIV Human Immunodeficiency Virus HRS AKI-HRS-Acute Kidney Injury HRS Hepatorenal syndrome IAC International Ascites Club INR International Normalized Ratio MAP Mean Arteria Pressure MELD Model for End-Stage Liver Disease MNH Muhimbili National Hospital MUHAS Muhimbili University of Health and Allied Sciences SBP Spontaneous Bacterial Peritonitis UGIB Upper Gastro Intestinal Bleeding Declarations Acknowledgements We firmly acknowledge the cooperation we received from MUHAS, Departments of Internal Medicine, Staff from MNH, Departments of Internal Medicine, my colleagues in internal medicine, Masters of Medicine Students from MUHAS, and Data collectors. We finally thank all patients who willingly participated in this study. Authors Contributions The concept development and methodology; by Joshua Karaba, Abdallah Njate, Abbas Godian, Data collection and analysis; Joshua Karaba, Jonhas Masatu David Osima, Abdallah Njate, Abbas Godian, Preparation of the preliminary draft: Joshua Karaba, Jonhas Masatu David Osima, Abdallah Njate and Abbas Godian and Supervision and Revisions: Amunga Meda and Ewaldo Komba. Funding This study received no external funding. Data availability The datasets collected and/or analyzed during the study are not publicly available due to privacy concerns, ethical constraints, and institutional policies, but can be obtained from the corresponding author upon reasonable request. Ethics approval and consent to participate All procedures used in this study followed and adhered to rules and regulations, such as the Declaration of Helsinki, World Health Regulation and rules, and Tanzania Ministry of Health Regulations Guidelines. The ethical approval was obtained from the MUHAS Institutional Review Board with certificate number Ref. No. MNH/TRCU/PERM/2024/348. Permission to conduct the study was granted by MNH management with reference letter Ref. No. MNH/TRCU/PERM/2024/348. Consent for publication All authors voluntarily agreed to publish this study. Artificial Intelligence (AI) disclosure The authors didn’t used AI in developing, analysis of data and writing this manuscript. Competing interests The authors declare no competing interests. References Adebayo D, Wong F (2023) Pathophysiology of Hepatorenal Syndrome – Acute Kidney Injury. 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Randomized Controlled Study 13(12):1–10 Wong F, Pantea L, Sniderman K (n.d.). Midodrine, Octreotide, Albumin, and TIPS in Selected Patients With Cirrhosis and Type 1 Hepatorenal Syndrome . 55–64. https://doi.org/10.1002/hep.20262 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 18 Feb, 2026 Reviews received at journal 17 Feb, 2026 Reviews received at journal 15 Feb, 2026 Reviewers agreed at journal 12 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviewers invited by journal 09 Feb, 2026 Editor assigned by journal 08 Feb, 2026 Submission checks completed at journal 05 Feb, 2026 First submitted to journal 03 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Sciences","correspondingAuthor":false,"prefix":"","firstName":"Abbas","middleName":"","lastName":"Godian","suffix":""},{"id":588397319,"identity":"3d3ef856-4f17-4134-8c53-efa07edecf6a","order_by":5,"name":"Amunga Meda","email":"","orcid":"","institution":"Muhimbili National Hospital","correspondingAuthor":false,"prefix":"","firstName":"Amunga","middleName":"","lastName":"Meda","suffix":""},{"id":588397321,"identity":"c4763e4e-c6d8-4812-9b96-93729a7d6ca6","order_by":6,"name":"Ewaldo Komba","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ewaldo","middleName":"","lastName":"Komba","suffix":""}],"badges":[],"createdAt":"2026-02-03 16:39:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8778470/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8778470/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102442457,"identity":"a50866b6-8dea-4252-b41a-142814dc5623","added_by":"auto","created_at":"2026-02-11 17:05:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":228869,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u0026nbsp;\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8778470/v1/d0167aaf75a411c706560f81.png"},{"id":102442458,"identity":"895f5d78-a62a-4a61-ae1d-504da0f855e7","added_by":"auto","created_at":"2026-02-11 17:05:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":242855,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u0026nbsp;\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8778470/v1/0eed5a57ab4bf002201a3c4c.png"},{"id":102746065,"identity":"c6552085-c4f5-4632-be66-82d38cf9a9e3","added_by":"auto","created_at":"2026-02-16 08:55:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1623085,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8778470/v1/9a9d92a3-2dff-4a68-8698-b0b6b627fb5d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Determinants of Hepatorenal Syndrome among Adults with Decompensated Advanced Chronic Liver Disease admitted at Muhimbili National Hospital, Dar Es Salaam, Tanzania","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHRS is a functional kidney failure that occurs in patients with advanced portal hypertension and systemic circulatory dysfunction in the absence of intrinsic kidney disease(Progress \u0026amp; Schrier, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Kerrigan et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). It is one of the most severe complications of dACLD and is associated with poor prognosis and high short-term mortality(Sodium, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Kerrigan et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Studies show that its pathophysiology involves splanchnic vasodilatation, arterial underfilling, and renal vasoconstriction, which ultimately reduce renal perfusion(Simonetto et al., 202;Roozbeh et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, the prevalence of HRS among dACLD ranges between 7.9% and 23.9%, depending on patient characteristics and diagnostic criteria(Roozbeh et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e;Lalaina et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e;Pose et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e;Thapa et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, Pakistan, Madagascar, and most of the Asian countries reported HRS prevalences of 11.9% and 7.9%, respectively. On the other hand, Colombia reported rates up to 23.9%(Guidelines, 201;Pose et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).The HRS typically occurs commonly among dACLD patients and is often triggered by precipitating events such as Spontaneous Bacterial Peritonitis (SBP), gastrointestinal bleeding, or large-volume paracentesis without albumin support (Seshadri et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e;Tiwari et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2025\u003c/span\u003e;. The evolution of diagnostic criteria by the International Ascites Club (IAC) in 2015 and 2021 has improved recognition of early HRS-Acute Kidney Injury (HRS-AKI), allowing earlier treatment (Progress \u0026amp; Schrier, 200;Ali et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e;Sendra, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Despite the fact that determinants of HRS have been identified including hyponatremia, hypoalbuminemia, bilirubin, and high Model for End-Stage Liver Disease (MELD) scores there are regional variations due to genetic and healthcare differences (Adebayo \u0026amp; Wong, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e;Lenz et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e;Simonetto et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eData from sub-Saharan Africa remain scarce; to date, only one study from Madagascar has reported HRS prevalence(Roozbeh et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). No similar data exist from Tanzania, despite the increasing burden of chronic liver disease and admissions due to dACLD(Ayal et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Plan et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Understanding the magnitude and predictors of HRS is crucial for early diagnosis, timely management, and rational allocation of limited resources such as albumin and vasoconstrictor therapies(MoH, 2018;Amico et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2006\u003c/span\u003e);Fida et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This study aimed to assess the prevalence and determinants of hepatorenal syndrome among adults with dACLD admitted at MNH, Dar es Salaam, Tanzania.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eWe conducted a hospital‑based cross-sectional study at MNH, Dar es Salaam, Tanzania, from August 2024 to January 2025. The MNH is a government-owned tertiary hospital located in Upanga, Dar es Salaam, Tanzania. MNH has a National Reference Laboratory and Central Pathology Laboratory (CPL); it serves as a teaching entity for various health specialties and superspecialists and serves a population exceeding 4\u0026nbsp;million people. It has about a 1500-bed capacity and attends to about 1000 outpatients and 1000 inpatients per week. MNH has a total of over 20 certified adult gastroenterologists allocated in the gastro-hepatology subunit that serves as a National Referral Point for gastroenterology- and hepatology-related cases from different referral hospitals throughout Tanzania and other East African countries. The unit manages patients with dACLD. Therefore, make it a suitable study setting for this study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling and study population\u003c/h3\u003e\n\u003cp\u003e We employed a consecutive sampling technique involving selecting every patient admitted with dACLD who meets the inclusion criteria until the sample size of 100 patients was attained. We included dACLD patients aged 18 years and above; however, we excluded dACLD patients, patients with preexisting renal disease, and patients who had undergone renal transplantation.\u003c/p\u003e\n\u003ch3\u003eSample size calculations\u003c/h3\u003e\n\u003cp\u003eThe sample size for this study was estimated using the Kish Leslie formula for cross-sectional studies, with finite population correction. The formula given is:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=Nx\\frac{\\frac{{z}^{2}.p(1-p)}{{e}^{2}}}{[N-1+\\left(\\frac{{z}^{2}.p\\left(1-p\\right)}{{e}^{2}}\\right)]}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhere \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n\\)\u003c/span\u003e\u003c/span\u003e = minimum sample size required\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;Z-score for 95% confidence interval which is 1.96\u003c/p\u003e \u003cp\u003ee= Margin of error set at 5% (0.05)\u003c/p\u003e \u003cp\u003eN= Total number of decompensated advanced chronic liver disease patients expected to be available during the study period.\u003c/p\u003e \u003cp\u003eBased on hospital records, approximately 30 patients with decompensated cirrhosis were admitted monthly at MNH, giving an estimated population of 180 patients over six-month recruitment period (N\u0026thinsp;=\u0026thinsp;180).\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(\\:p\\)\u003c/span\u003e \u003c/span\u003e is the estimated prevalence of HRS. A prevalence of 11.9% (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.119) was adopted from a study in Pakistan(Ali et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\(\\:n\\)\u003c/span\u003e \u003c/span\u003e= 84/0.90 (Taking into consideration 10% non-response rate)\u003c/p\u003e \u003cp\u003eTherefore, the estimated sample size was 100.\u003c/p\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDependent variable\u003c/h2\u003e \u003cp\u003eThe dependent variable was HRS, which was diagnosed following the International Ascites Club (2015/2021) criteria and measured as hyponatremia: serum sodium\u0026thinsp;\u0026lt;\u0026thinsp;125 mmol/L; hypoalbuminemia: serum albumin\u0026thinsp;\u0026lt;\u0026thinsp;2.5 g/dL. Shock: SBP\u0026thinsp;\u0026lt;\u0026thinsp;90 mmHg or MAP\u0026thinsp;\u0026lt;\u0026thinsp;70 mmHg with hypoperfusion and categorized as Yes or No as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003eIndependent variables were sociodemographic (age range and sex); Laboratory Parameters; (level of hemoglobin, count of platelets, level of serum sodium, level of potassium, level of serum albumin, total bilirubin, Blood Urea Nitrogen (BUN), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), International Normalized Ratio (INR), and Human Immunodeficiency Virus (HIV) status, hepatitis B status, and status of hepatitis C). Clinical features: a fever, jaundice, splenomegaly, oedema in the lower limbs, bleeding in the upper gastrointestinal tract (UGIB), ascites, grade of hepatic encephalopathy, spontaneous bacterial peritonitis, Child-Pugh class and MELD category of risk. As well as Risk factors; Drinking alcohol and Infection with schistosomiasis. The conceptual frame work of study variables are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eWe used the standardized questionnaires to collect sociodemographic data, laboratory investigations, clinical findings and risk factors. The data was collected by trained Medical Doctors who were working at the Internal Medicine wards at MNH. They have two days of training on data collection tools, ethical issues and sampling procedures.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData collected was entered in Microsoft Excel and analyzed using STATA version 15. Descriptive statistics summarized characteristics using proportion, and the continuous variables were categorized using median and interquartile range. The determinants of HRS were first explored using bivariate analyses whereby variables with p\u0026thinsp;\u0026le;\u0026thinsp;0.20 or clinical relevance were entered into a multivariable robust modified Poisson regression model to estimate adjusted prevalence ratios (aPR) with a p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 and at 95% CI.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003ewas obtained from the MUHAS Institutional Review Board with certificate number Ref. No. MNH/TRCU/PERM/2024/348. Permission to conduct the study was granted by MNH management with reference letter Ref. No. MNH/TRCU/PERM/2024/348. Written informed consent was obtained from all participants. Confidentiality was ensured through anonymized identification numbers and secure data handling. On the other hand, all patients found with HRS or other diagnoses were managed by adhering to local and international hospital protocols; the investigators did not interfere with care.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eA total of 100 adults with dACLD were enrolled between August 2024 and January 2025. Of these, 69% were male, and the median age was 46 years (interquartile range 37-58.5) as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocial demographics of study Participant characteristics (N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial demographics variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequencies(N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentages (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAge Median Age\u0026thinsp;=\u0026thinsp;46.0 IQR [37-58.5]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eClinical features\u003c/h2\u003e \u003cp\u003eMost patients presented with ascites (91%), jaundice (80%), and peripheral oedema (78%), while 22% had hepatic encephalopathy at admission. The leading etiologies of liver disease were chronic viral hepatitis B (39%), other Clinical features are summarized in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical features of study participant characteristics (N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCLINICAL FEATURES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFREQUENCIES(N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePERCENTAGES (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJaundice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSplenomegaly\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLower limb edema\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUGIB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAscites\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinically diagnosed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosed by USS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo hepatic Encephalopathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSBP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCTP class\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 .0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass C\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 .0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMELD score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtremely high risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery high risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTOTAL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLaboratory Parameters\u003c/h2\u003e \u003cp\u003eIn term of Laboratory evaluation showed a mean serum sodium of 127\u0026thinsp;\u0026plusmn;\u0026thinsp;6mmol/l, mean albumin 2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 g/dL, and median total bilirubin 3.1 mg/dL (IQR 1.8\u0026ndash;6.2). Overall, 32% of participants had hyponatremia (\u0026lt;\u0026thinsp;125 mmol/L) and 49% had hypoalbuminemia (\u0026lt;\u0026thinsp;2.5 g/dL). However, Child-Pugh classification found that 65% were in Class C and 35%, Class B, other Laboratory Parameters are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLaboratory Parameters of study participant characteristics (N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLABORATORY PARAMETERS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFREQUENCIES(N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePERCENTAGE (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb level (g/dl)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlatelet count (x103/l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSodium level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater or equal to 125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePotassium level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperkalemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypokalemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSerum Albumin levels\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater or equal to 2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Bilirubin level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBUN (mmol/l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCritically high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild elevation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate elevation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere elevation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithin normal range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAST\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelow normal range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild elevation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate elevation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere elevation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithin normal range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eINR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged (mild)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged (moderate)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHIV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHepatitis B\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHepatitis C\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTOTAL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors for HRS among adults\u0026rsquo; patients with dACLD admitted at MNH\u003c/h2\u003e \u003cp\u003eOur study found that 49% of participants use alcohol, and 13.0% have a history of Schistosomiasis infection as the risk factor for HRS shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk factors for HRS among adults\u0026rsquo; patients with dACLD admitted at MNH (N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRISK FACTORS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFREQUENCIES (N\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePERCENTAGES (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumption\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSchistosomiasis infection\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTOTAL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of HRS among adults\u0026rsquo; patients with dACLD admitted at MNH\u003c/h2\u003e \u003cp\u003eUsing the International Ascites Club 2015/2021 criteria, our study found 11% with CI (85% CI 5.0\u0026ndash;18.0) at 95% prevalence of HRS among 100 adults\u0026rsquo; patients with dACLD admitted at MNH.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eDeterminants of HRS among Adults patients dACLD admitted at MNH\u003c/h2\u003e \u003cp\u003eAfter adjustment for confounders, Our study found that, hyponatremia and hypoalbuminemia determinants of HRS among adults\u0026rsquo; patients with dACLD admitted at MNH, where by patients with Hyponatremia was 3.95 more likely to have HRS compared to one with no hyponatremia (aPR 3.95; 95% CI 1.36\u0026ndash;11.51; p\u0026thinsp;=\u0026thinsp;0.012), and patients with hypoalbuminemia were 4.94 more like to have HRS compare to one with no hypoalbuminemia (aPR 4.94; 95% CI 1.20\u0026ndash;20.28; p\u0026thinsp;=\u0026thinsp;0.027). However, the patients with UGIB were 2.11 more likely to have HSR compared to one with no UGIB (aPR 2.11; 95% CI 0.71\u0026ndash;6.24; p\u0026thinsp;=\u0026thinsp;0.18), but its association was not statistically significant. In another MELD category and bilirubin did not show any association with HRS. The results are summarized in Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable analysis of the Determinants of HRS among Adults patients dACLD admitted at MNH\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHRS n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecPR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaPR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium level (mmol/l)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater or equal to 125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.72 (1.17\u0026ndash;11.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.95 (1.36\u0026ndash;11.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSerum Albumin levels (g/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.88 (1.10\u0026ndash;21.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.94 (1.20-20.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater or equal to 2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUGIB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.89 (2.89-0.81-10.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e274 (0.80\u0026ndash;9.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003ecPR =crude Prevalence Ratio, aPR =adjusted Prevalence Ratio\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prevalence of HRS among dACLD patients at MNH was very low whereby hyponatremia and hypoalbuminemia were the key determinants. The observed prevalence of 11% is comparable to that reported in Pakistan (11.9%) and slightly higher than Madagascar (11.9%) and slightly higher than Madagascar (7.9%), but lower than findings from Colombia (23.9%)(Roozbeh et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2024\u003c/span\u003e;Lalaina et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e;Pose et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These variations likely reflect differences in disease etiology, severity at presentation and diagnostic thresholds applied across regions(Thapa et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e;Simonetto et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHyponatremia and hypoalbuminemia are the determinants of HRS, consistent with findings from other international studies(Adebayo \u0026amp; Wong, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e;Lenz et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e(Wong et al., n.d.). This is due to the fact that hyponatremia indicates severe circulatory dysfunction due to arterial underfilling and activation of vasoconstrictor systems, which contributes directly to renal hypoperfusion(Adebayo \u0026amp; Wong, 202;Lenz et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Hypoalbuminemia, on the other hand, reflects impaired hepatic synthetic function and worsened oncotic pressure, further compromising effective circulating volume and renal perfusion(Simonetto et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e;Salerno et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study found that MELD is not the determinant of HRS among dACLD patients. This is contrary to previous studies which showed MELD score and bilirubin levels increase the risk for HRS(Arroyo et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2008\u003c/span\u003e(Salerno et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2007\u003c/span\u003e);Patidar et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). These differences may be due to the small sample size in our study as well as the study design we employed or the dominant influence of sodium and albumin abnormalities in the Tanzanian patients.\u003c/p\u003e \u003cp\u003eThe findings from our study underscore the importance of early biochemical screening in patients with dACLD. Identifying hyponatremia and hypoalbuminemia can help clinicians initiate preventive measures and priorities high-risk patients for albumin supplementation or vasoconstrictor therapy(Wong et al., 2020;Liu et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2021\u003c/span\u003e;Progress \u0026amp; Schrier, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite limitations, this study bridges a major local knowledge gap by providing baseline Tanzanian data on HRS. It reinforces the clinical relevance of sodium and albumin as prognostic markers and supports resource prioritization for early diagnosis and supportive treatment in dACLD (Patidar et al., 202;Ayal et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2025\u003c/span\u003e;Plan et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e "},{"header":"Conclusion and Recommendations","content":"\n\u003ch3\u003eConclusion\u003c/h3\u003e\n\u003cp\u003eThe prevalence of HRS among dACLD patients at MNH was very low whereby hyponatremia and hypoalbuminemia were the key determinants.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eWe recommend the following to the tertiary hospitals, Ministry of Health and healthcare providers to:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealth care providers to ensure routinely monitor serum sodium and albumin in all patients with dACLD and initiate early supportive care where abnormalities are detected.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHospitals management, and Ministry of Health to ensure the availability of albumin and vasoconstrictor therapy and develop context-appropriate diagnostic algorithms.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo conduct Further research should explore cost-effective preventive strategies and long-term outcomes to improve prognosis in Tanzanian patients with advanced liver disease.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArtificial Intelligence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eALT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAlanine Aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Prevalence Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAspartate Aminotransferase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBUN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBlood Urea Nitrogen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCentral Pathology Laboratory\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCRP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrude Prevalence Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003edACLD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDecompensated Advanced Chronic Liver Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAKI-HRS-Acute Kidney Injury\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHepatorenal syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIAC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Ascites Club\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eINR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Normalized Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMean Arteria Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMELD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eModel for End-Stage Liver Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMNH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMuhimbili National Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMUHAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMuhimbili University of Health and Allied Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSpontaneous Bacterial Peritonitis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUGIB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUpper Gastro Intestinal Bleeding\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe firmly acknowledge the cooperation we received from MUHAS, Departments of Internal Medicine, Staff from MNH, Departments of Internal Medicine, my colleagues in internal medicine, Masters of Medicine Students from MUHAS, and Data collectors. We finally thank all patients who willingly participated in this study.\u003c/p\u003e\n\u003cp\u003eAuthors Contributions\u003c/p\u003e\n\u003cp\u003eThe concept development and methodology; by Joshua Karaba, Abdallah Njate, Abbas Godian, Data collection and analysis; Joshua Karaba, Jonhas Masatu David Osima, Abdallah Njate, Abbas Godian, Preparation of the preliminary draft: Joshua Karaba, Jonhas Masatu David Osima, Abdallah Njate and Abbas Godian and Supervision and Revisions: Amunga Meda and Ewaldo Komba. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study received no external funding.\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe datasets collected and/or analyzed during the study are not publicly available due to privacy concerns, ethical constraints, and institutional policies, but can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eAll procedures used in this study followed and adhered to rules and regulations, such as the Declaration of Helsinki, World Health Regulation and rules, and Tanzania Ministry of Health Regulations Guidelines. The ethical approval was obtained from the MUHAS Institutional Review Board with certificate number Ref. No. MNH/TRCU/PERM/2024/348. Permission to conduct the study was granted by MNH management with reference letter Ref. No. MNH/TRCU/PERM/2024/348.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eAll authors voluntarily agreed to publish this study.\u003c/p\u003e\n\u003cp\u003eArtificial Intelligence (AI) disclosure\u003c/p\u003e\n\u003cp\u003eThe authors didn\u0026rsquo;t used AI in developing, analysis of data and writing this manuscript.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdebayo D, Wong F (2023) Pathophysiology of Hepatorenal Syndrome \u0026ndash; Acute Kidney Injury. 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Randomized Controlled Study 13(12):1\u0026ndash;10\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong F, Pantea L, Sniderman K (n.d.). \u003cem\u003eMidodrine, Octreotide, Albumin, and TIPS in Selected Patients With Cirrhosis and Type 1 Hepatorenal Syndrome\u003c/em\u003e. 55\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/hep.20262\u003c/span\u003e\u003cspan address=\"10.1002/hep.20262\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bulletin-of-the-national-research-centre","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnrc","sideBox":"Learn more about [Bulletin of the National Research Centre](https://BNRC.springeropen.com)","snPcode":"42269","submissionUrl":"https://submission.springernature.com/new-submission/42269/3","title":"Bulletin of the National Research Centre","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prevalence, Determinants, Hepatorenal Syndrome, Decompensated Advanced Chronic Liver Disease, Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-8778470/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8778470/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHepatorenal syndrome (HRS) is a severe complication of Decompensated Advanced Chronic Liver Disease (dACLD) with more than 80% mortality when not well treated. There is no published Tanzanian evidence on its prevalence and determinants. Therefore, this study aimed to assess the prevalence and determinants of hepatorenal syndrome among adults with dACLD admitted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a hospital‑based cross-sectional study over six months (August 2024 to January 2025) among 100 consecutively enrolled adults with dACLD at MNH. Data on sociodemographic, clinical, and laboratory characteristics were collected. HRS was diagnosed using International Ascites Club (2015/2021) criteria. Stata 15 was used to analyze the data, and multivariable Poisson regression with robust standard errors was used to assess the determinants of HRS, where variables with a bivariable p-value\u0026thinsp;\u0026le;\u0026thinsp;0.2 at 95% Confidence Interval (CI) were taken to multivariable, and the significance was measured at the p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 at 95% CI.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of HRS was 11.0% (95% CI 5.0\u0026ndash;18.0). The determinants of HRS were hyponatremia (serum sodium\u0026thinsp;\u0026lt;\u0026thinsp;125 mmol/L) and hypoalbuminemia (serum albumin\u0026thinsp;\u0026lt;\u0026thinsp;2.5 g/dL), which were independently associated with HRS (aPR 3.95, 95% CI 1.36\u0026ndash;11.51; and aPR 4.94, 95% CI 1.20\u0026ndash;20.28, respectively). However, other clinical factors, including upper gastrointestinal bleeding and higher Model for End-Stage Liver Disease (MELD) category, showed positive association but were not statistically significant.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prevalence of HRS among dACLD patients at MNH was 11.0%, whereby hyponatremia and hypoalbuminemia were the key determinants. This underscores the need for routine monitoring of sodium and albumin to flag high‑risk patients, and timely access to supportive therapies should be prioritized.\u003c/p\u003e","manuscriptTitle":"Prevalence and Determinants of Hepatorenal Syndrome among Adults with Decompensated Advanced Chronic Liver Disease admitted at Muhimbili National Hospital, Dar Es Salaam, Tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 17:05:46","doi":"10.21203/rs.3.rs-8778470/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-18T16:54:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T10:33:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T06:29:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71423544829835491737897380804726900463","date":"2026-02-12T09:25:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330458237589342957938183770302131621519","date":"2026-02-11T08:08:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-09T15:07:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-08T19:28:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-05T13:09:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bulletin of the National Research Centre","date":"2026-02-03T16:18:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bulletin-of-the-national-research-centre","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnrc","sideBox":"Learn more about [Bulletin of the National Research Centre](https://BNRC.springeropen.com)","snPcode":"42269","submissionUrl":"https://submission.springernature.com/new-submission/42269/3","title":"Bulletin of the National Research Centre","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"87990ae2-616b-41c9-b625-1f18fd90f399","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-02T14:38:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 17:05:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8778470","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8778470","identity":"rs-8778470","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}