Terlipressin and albumin for type-1 hepatorenal syndrome associated with sepsis.

Abstract

BACKGROUND & AIMS:

Terlipressin and albumin is the standard of care for classical type-1 hepatorenal syndrome (HRS) not associated with active infections. However, there is no information on efficacy and safety of this treatment in patients with type-1 HRS associated with sepsis. Study aim was to investigate the effects of early treatment with terlipressin and albumin on circulatory and kidney function in patients with type-1 HRS and sepsis and assess factors predictive of response to therapy.

METHODS:

Prospective study in 18 consecutive patients with type-1 HRS associated with sepsis.

RESULTS:

Treatment was associated with marked improvement in arterial pressure and suppression of the high levels of plasma renin activity and norepinephrine. Response to therapy (serum creatinine <1.5mg/dl) was achieved in 12/18 patients (67%) and was associated with improved 3-month survival compared to patients without response. Non-responders had significantly lower baseline heart rate, poor liver function tests, slightly higher serum creatinine, and higher Child-Pugh and MELD scores compared to responders. Interestingly, non-responders had higher values of CLIF-SOFA score compared to responders (14±3 vs. 8±1, respectively p<0.001), indicating greater severity of acute-on-chronic liver failure (ACLF). A CLIF-SOFA score ⩾11 had 92% sensitivity and 100% specificity in predicting no response to therapy. No significant differences were observed between responders and non-responders in baseline urinary kidney biomarkers. Treatment was safe and no patient required withdrawal of terlipressin.

CONCLUSIONS:

Early treatment with terlipressin and albumin in patients with type-1 HRS associated with sepsis is effective and safe. Patients with associated severe ACLF are unlikely to respond to treatment.

• Authors: Ezequiel Rodríguez, Chiara Elia, Elsa Solà, Rogelio Barreto, Isabel Graupera, Alida Andrealli, Gustavo Pereira, Maria Poca, Jordi Sánchez, Mónica Guevara, Germán Soriano, Carlo Alessandria, Javier Fernández, Vicente Arroyo, Pere Ginès
• Journal: Journal of hepatology (J Hepatol) Vol. 60 Issue 5 Pg. 955-61 (May 2014) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 24447876 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Chemical References

• Albumins
• Lypressin
• Terlipressin
• Creatinine

Topics

• Aged
• Albumins (therapeutic use)
• Blood Pressure
• Creatinine (blood)
• Female
• Heart Rate
• Hepatorenal Syndrome (complications, drug therapy, physiopathology)
• Humans
• Kidney (physiopathology)
• Liver Failure (complications, drug therapy, physiopathology)
• Lypressin (analogs & derivatives, therapeutic use)
• Male
• Middle Aged
• Prospective Studies
• Sepsis (complications, drug therapy)
• Terlipressin
• Treatment Outcome