Noradrenaline vs. terlipressin in the treatment of hepatorenal syndrome: a randomized study.

Abstract

BACKGROUND & AIMS:

Various vasoconstrictors are useful in the management of hepatorenal syndrome (HRS). Terlipressin is the drug of choice; however, it is expensive. In this study, we evaluated safety and efficacy of terlipressin and noradrenaline in the treatment of HRS.

METHODS:

Forty-six patients with HRS type 1 were managed with terlipressin (group A, N=23) or noradrenaline (Group B, N=23) with albumin in a randomized controlled trial at a tertiary center.

RESULTS:

HRS reversal could be achieved in 9 (39.1%) patients in group A and 10 (43.4%) patients in group B (p=0.764). Univariate analysis showed baseline Child Turcotte Pugh score (CTP), model of end stage liver disease (MELD), urine output on day 1(D1), albumin, and mean arterial pressure (MAP) were associated with response. However, on multivariate analysis only CTP score was associated with response. Fourteen patients in group A and 12 in group B died at day 15 (p>0.05). Noradrenaline was less expensive than terlipressin (p<0.05). No major adverse effects were seen.

CONCLUSIONS:

The results of this randomized study suggest that noradrenaline is as safe and effective as terlipressin, but less expensive in the treatment of HRS and baseline CTP score is predictive of response.

• Authors: Virendra Singh, Souvik Ghosh, Baljinder Singh, Pradeep Kumar, Navneet Sharma, Ashish Bhalla, A K Sharma, N S Choudhary, Yogesh Chawla, C K Nain
• Journal: Journal of hepatology (J Hepatol) Vol. 56 Issue 6 Pg. 1293-8 (Jun 2012) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 22322237 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Chemical References

• Lypressin
• Terlipressin
• Norepinephrine

Topics

• Adult
• Aged
• Blood Pressure (drug effects)
• Female
• Hepatorenal Syndrome (blood, drug therapy, physiopathology)
• Humans
• Lypressin (analogs & derivatives, therapeutic use)
• Male
• Middle Aged
• Norepinephrine (therapeutic use)
• Terlipressin