A Prospective Observational Study on Renal Resistive Index as an Early Predictor of Hepatorenal Syndrome

Cirrhosis is a major cause of morbidity, frequently leading to complications like hepatorenal syndrome (HRS). Diagnosing HRS is difficult, as serum creatinine (SCr), commonly used to assess renal dysfunction, has significant limitations in cirrhosis. This study explored renal resistive index (RRI) as a potential alternative for early detection of HRS.This study aimed to evaluate the utility of RRI as an early predictor of HRS in cirrhotic adults admitted to a tertiary intensive care unit (ICU).

A prospective observational study was conducted on 78 cirrhotic adult ICU patients. Renal resistive index was measured within 24 hours of admission. Clinical, biochemical, and ultrasound parameters were collected. Statistical analyses included analysis of variance (ANOVA), t-tests, Pearson correlation, logistic regression, and receiver operating characteristic (ROC) analysis.

Of 78 patients, 88.5% were male and 78.2% had alcohol-related cirrhosis. Hepatorenal syndrome occurred in 30.8% of cases. Renal resistive index showed a strong correlation with ascites grade, MELD-Na, and Child-Pugh class. Receiver operating characteristic analysis revealed RRI >0.705 had 87.5% sensitivity and 87.0% specificity in predicting HRS. The RRI elevation preceded the SCr rise by 24-48 hours. Backward stepwise conditional logistic regression, however, identified ascitic grade as the independent predictor of HRS (p < 0.001).

Although ascitic grade was the sole independent predictor of HRS in our multivariate model, RRI was strongly associated with HRS onset and may offer additional utility alongside clinical parameters for early identification of at-risk patients.

Peter D, Kuruvilla CS, John JK. A Prospective Observational Study on Renal Resistive Index as an Early Predictor of Hepatorenal Syndrome. Indian J Crit Care Med 2026;30(3):231-236.