title: Predictors of response to therapy with terlipressin and albumin in patients with cirrhosis and type 1 hepatorenal syndrome.
abstract: 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).
  
  
  CONCLUSIONS
  Serum bilirubin and an early increase in arterial pressure predict response to treatment with terlipressin and albumin in type 1 HRS. Alternative treatment strategies to terlipressin and albumin should be investigated for patients with type 1 HRS and low likelihood of response to vasoconstrictor therapy.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain.
authors.forename: André
authors.initials: A
authors.lastname: Nazar
authors.forename: Gustavo Henrique
authors.initials: GH
authors.lastname: Pereira
authors.forename: Mónica
authors.initials: M
authors.lastname: Guevara
authors.forename: Marta
authors.initials: M
authors.lastname: Martín-Llahi
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Pepin
authors.forename: Marcella
authors.initials: M
authors.lastname: Marinelli
authors.forename: Elsa
authors.initials: E
authors.lastname: Solá
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Baccaro
authors.forename: Carlos
authors.initials: C
authors.lastname: Terra
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D000368:Aged; D000418:Albumins / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D000077585:Terlipressin
chemical_list: D000418:Albumins; D000959:Antihypertensive Agents; D008236:Lypressin; D000077585:Terlipressin; D003404:Creatinine