Clinical course, predictive factors and prognosis in patients with cirrhosis and type 1 hepatorenal syndrome treated with Terlipressin: a retrospective analysis.
OBJECTIVE
Terlipressin has been proposed to treat renal failure in patients with type 1 hepatorenal syndrome (HRS). However, the predictive factors for improved renal function and survival are unknown in patients with type 1 HRS treated with terlipressin. The aim of the present retrospective study was to investigate the predictive factors and prognosis of patients with type 1 HRS treated with terlipressin.


METHODS
The clinical charts of 18 consecutive patients with cirrhosis and type 1 HRS treated with terlipressin were studied. The predictive factors for improved renal function and survival were identified using univariate analyses.


RESULTS
Improved renal function, indicated by a significant decrease in serum creatinine (61 +/- 4%), occurred in 11 (60%) patients. The only predictive factor for improved renal function was a Child-Pugh's score < or =13 at the time of diagnosis of HRS (P = 0.02). Fifteen patients (83%) died at 45 days and the median survival was 24 days. Of the three patients who survived, two underwent successful orthotopic liver transplantation. Three predictive factors for survival were identified: absence of a precipitating factor for HRS (P = 0.012); improved renal function during terlipressin therapy (P = 0.05); and a dose of terlipressin > or =3 mg/day (P = 0.04).


CONCLUSIONS
In patients with type 1 HRS treated with terlipressin, patients with improved renal function had less severe cirrhosis (Child-Pugh >10 but < or =13) than patients without. The predictive factors for survival were the absence of a precipitating factor for HRS, the terlipressin-induced improvement in renal function and a dose of terlipressin of at least 3 mg/day. These findings suggest that a randomized controlled trial investigating the effect of terlipressin on survival in patients with type 1 HRS should be performed.
Colle
Isabelle
I
Laboratoire d'Hémodynamique Splanchmique et de Biologie Vasculaire, Institut National de la Santé et de la Recherge Médicale, Clinchy, France. Isabelle.Colle@rug.ac.be
Durand
François
F
Pessione
Fabienne
F
Rassiat
Emmanuel
E
Bernuau
Jacques
J
Barrière
Eric
E
Lebrec
Didier
D
Valla
Dominique-Charles
DC
Moreau
Richard
R
D000328:Adult; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin