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: