Poor outcomes with treatment of hepatorenal syndrome type 1 with splanchnic vasoconstrictors and albumin: report of seven cases and review of the literature.
BACKGROUND
Treatment of hepatorenal syndrome type 1 (HRS-1) with splanchnic vasoconstrictors and high-dose albumin has been associated with reversal of renal failure in approximately 60% to 80% of the cases in pilot or uncontrolled studies.


OBJECTIVE
To evaluate the results of treatment of HRS-1 with terlipressin and high-dose albumin.


METHODS
All patients with HRS-1 that underwent treatment with terlipressin and high-dose albumin at our unit were retrospectively reviewed. Outcomes including reversal of renal failure and death were recorded and compared to baseline clinical and laboratory parameters.


RESULTS
Seven subjects (median age 64 [47-69] years, 5 males) with median Child-Pugh and MELD scores of 12 [10-15] and 22 [17-38], respectively, hospitalized with decompensated chronic liver disease secondary to tense ascitis and infections, who exhibited criteria for HRS-1, were submitted to therapy with terlipressin and high-dose albumin according to a predefined standard protocol. Baseline creatinine levels were 2.9 [2.3-4.0] mg/mL. None of the patients achieved reversal of HRS-1 and five subjects died on-treatment due to sudden-death (n = 1), multiple organ dysfunction associated with end-stage liver failure (n = 2) and sepsis (n = 2).


CONCLUSIONS
Treatment of HRS-1 with terlipressin and high-dose albumin was not associated with reversal of renal failure, but most of the treated subjects had severe end-stage liver disease with high MELD scores as well as high baseline creatinine values, parameters previously associated with bad outcomes.
Kalil
Jamile Rosário
JR
Unit of Gastroenterology and Hepatology, Hospital Português, Salvador, BA, Brazil.
Cerqueira
Liv Aparicio
LA
Barbosa
Daniel Silva
DS
Motta
Marina Pamponet
MP
Nery
Marília da Silva
Mda S
Bittencourt
Paulo Lisboa
PL
D000368:Aged; D000418:Albumins / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077585:Terlipressin; D017211:Treatment Failure; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000418:Albumins; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin