Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome.

Abstract

UNLABELLED:

Terlipressin plus albumin is an effective treatment for type 1 hepatorenal syndrome (HRS), but approximately only half of the patients respond to this therapy. The aim of this study was to assess predictive factors of response to treatment with terlipressin and albumin in patients with type 1 HRS. Thirty-nine patients with cirrhosis and type 1 HRS were treated prospectively with terlipressin and albumin. Demographic, clinical, and laboratory variables obtained before the initiation of treatment as well as changes in arterial pressure during treatment were analyzed for their predictive value. Response to therapy (reduction in serum creatinine <1.5 mg/dL at the end of treatment) was observed in 18 patients (46%) and was associated with an improvement in circulatory function. Independent predictive factors of response to therapy were baseline serum bilirubin and an increase in mean arterial pressure of >or=5 mm Hg at day 3 of treatment. The cutoff level of serum bilirubin that best predicted response to treatment was 10 mg/dL (area under the receiver operating characteristic curve, 0.77; P < 0.0001; sensitivity, 89%; specificity, 61%). Response rates in patients with serum bilirubin <10 mg/dL or >or=10 mg/dL were 67% and 13%, respectively (P = 0.001). Corresponding values in patients with an increase in mean arterial pressure >or=5 mm Hg or <5 mm Hg at day 3 were 73% and 36%, respectively (P = 0.037).

CONCLUSION:

Serum bilirubin and an early increase in arterial pressure predict response to treatment with terlipressin and albumin in type 1 HRS. Alternative treatment strategies to terlipressin and albumin should be investigated for patients with type 1 HRS and low likelihood of response to vasoconstrictor therapy.

• Authors: André Nazar, Gustavo Henrique Pereira, Mónica Guevara, Marta Martín-Llahi, Marie-Noëlle Pepin, Marcella Marinelli, Elsa Solá, María Eugenia Baccaro, Carlos Terra, Vicente Arroyo, Pere Ginès
• Journal: Hepatology (Baltimore, Md.) (Hepatology) Vol. 51 Issue 1 Pg. 219-26 (Jan 2010) ISSN: 1527-3350 [Electronic] United States
• PMID: 19877168 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Albumins
• Antihypertensive Agents
• Lypressin
• Terlipressin
• Creatinine

Topics

• Aged
• Albumins (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Blood Pressure (drug effects)
• Creatinine (blood)
• Female
• Hepatorenal Syndrome (drug therapy)
• Humans
• Liver Cirrhosis (drug therapy)
• Lypressin (analogs & derivatives, therapeutic use)
• Male
• Middle Aged
• Predictive Value of Tests
• Terlipressin