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.
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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)
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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
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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
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