Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study.
Vasopressin analogues associated with albumin improve renal function in hepatorenal syndrome (HRS). The current study was aimed at assessing the efficacy of the treatment, predictive factors of response, recurrence of HRS, and survival after therapy. Twenty-one consecutive patients with HRS (16 with type 1 HRS, 5 with type 2 HRS) received terlipressin (0.5-2 mg/4 hours intravenously) until complete response was achieved (serum creatinine level < 1.5 mg/dL) or for 15 days; 13 patients received intravenous albumin together with terlipressin. Twelve of the 21 patients (57%) showed complete response. Albumin administration was the only predictive factor of complete response (77% in patients receiving terlipressin and albumin vs. 25% in those receiving terlipressin alone, P =.03). Treatment with terlipressin and albumin was associated with a remarkable decrease in serum creatinine level, increase in arterial pressure, and suppression of the renin-aldosterone system. By contrast, no significant changes in these parameters were found in patients treated with terlipressin alone. Only 1 patient showed ischemic adverse effects. Recurrence of HRS occurred in 17% of patients with complete response. The occurrence of complete response was associated with an improved survival. In conclusion, terlipressin therapy reverses HRS in a high proportion of patients. Recurrence rate after treatment withdrawal is uncommon. Albumin appears to improve markedly the beneficial effects of terlipressin.
Ortega
Rolando
R
Liver Unit, Institut de Malalties Digestives, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Catalunya, Spain.
Ginès
Pere
P
Uriz
Juan
J
Cárdenas
Andrés
A
Calahorra
Blas
B
De Las Heras
Dara
D
Guevara
Mónica
M
Bataller
Ramón
R
Jiménez
Wladimiro
W
Arroyo
Vicente
V
Rodés
Juan
J
D000328:Adult; D000368:Aged; D000418:Albumins / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008236:Lypressin / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D000077585:Terlipressin
D000418:Albumins; D000959:Antihypertensive Agents; D008236:Lypressin; D000077585:Terlipressin