Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study.
OBJECTIVE
Type 1 hepatorenal syndrome (HRS) is a severe complication of cirrhosis associated with a short median survival time (<2 weeks). Although the administration of terlipressin improves renal function, its effect on survival is unknown. This study investigated predictive factors of survival in patients with type 1 HRS treated with terlipressin.


METHODS
Ninety-nine patients with type 1 HRS treated with terlipressin in 24 centers were retrospectively studied. Terlipressin-induced improved renal function was defined as a decrease in serum creatinine value to <130 micromol/L or a decrease of at least 20% at the end of treatment.


RESULTS
At inclusion, the Child-Pugh score was 11.8 +/- 1.6 (mean +/- SD). Terlipressin (3.2 +/- 1.3 mg/day) was administered for 11 +/- 12 days. Renal function improved in 58% of patients (serum creatinine decreased by 46% +/- 17% from 272 +/- 114 micromol/L). Median survival time was 21 days. Survival rate was 40% at 1 month. Multivariate analysis showed that improved renal function and Child-Pugh score < or =11 at inclusion were independent predictive factors of survival (P < 0.0001 and 0.02, respectively). Thirteen patients underwent liver transplantation (92 +/- 95 days after HRS onset), 10 of whom had received terlipressin and had had improved renal function.


CONCLUSIONS
This retrospective uncontrolled study shows that in patients with type 1 HRS, terlipressin-induced improved renal function is associated with an increase in survival. Thus, a randomized trial investigating the effect of terlipressin on survival in patients with type 1 HRS should be performed.
Moreau
Richard
R
INSERM U-481 et Service d'Hépatologie, Hôpital Beaujon, Clichy, France. moreau@bichat.inserm.fr
Durand
Francois
F
Poynard
Thierry
T
Duhamel
Christian
C
Cervoni
Jean-Paul
JP
Ichaï
Philippe
P
Abergel
Armand
A
Halimi
Chantal
C
Pauwels
Mathieu
M
Bronowicki
Jean-Pierre
JP
Giostra
Emile
E
Fleurot
Cathy
C
Gurnot
Danielle
D
Nouel
Olivier
O
Renard
Philippe
P
Rivoal
Michel
M
Blanc
Pierre
P
Coumaros
Dimitri
D
Ducloux
Sylvie
S
Levy
Stephane
S
Pariente
Alexandre
A
Perarnau
Jean-Marc
JM
Roche
Jean
J
Scribe-Outtas
Myriam
M
Valla
Dominique
D
Bernard
Brigitte
B
Samuel
Didier
D
Butel
Joël
J
Hadengue
Antoine
A
Platek
Andrzej
A
Lebrec
Didier
D
Cadranel
Jean-Francois
JF
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008236:Lypressin / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D051437:Renal Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D000077585:Terlipressin
D000959:Antihypertensive Agents; D008236:Lypressin; D000077585:Terlipressin