Lower uromodulin serum levels are associated with poorer prognosis in patients with cirrhosis and hepatorenal syndrome type 2.

Hepatorenal syndrome (HRS) is associated with a dismal prognosis in patients with cirrhosis, and therapeutic options are limited. Biomarkers to identify patients with poor response to therapy are urgently needed. This study aimed to evaluate the predictive value of serum levels of Uromodulin (sUMOD) in patients with cirrhosis and HRS treated with terlipressin and albumin (T/A). In total, 156 patients (81 patients with HRS treated with T/A, 42 patients with cirrhosis without kidney injury and 33 patients with cirrhosis with prerenal acute kidney injury (AKI)) were included. sUMOD levels were analysed by ELISA. Patients with HRS were prospectively followed for the composite endpoint of hemodialysis- / liver transplantation-free survival (HD/LTx-free survival). Of the 81 patients with HRS, 40 had HRS type 1 and 41 type 2. In the cohort of patients with HRS treated with T/A, median sUMOD level was 100 ng/ml (IQR 64;144). sUMOD differed significantly between patients with HRS compared to patients without AKI (p=0.001), but not between patients with HRS and prerenal AKI (p=0.9). In multivariable analyses, sUMOD levels in the lowest quartile were independently associated with a lower rate of complete response to T/A (OR 0.042, p=0.008) and a higher risk for reaching the composite endpoint of HD/LTX-free survival (HR 2.706,p=0.013) in patients with HRS type 2 treated with T/A. In contrast, sUMOD was not significantly associated with these outcomes in patients with HRS type 1. sUMOD may be a valuable biomarker for identifying patients with HRS type 2 treated with T/A to predict response and prognosis.