The effects of vasopressin and its analogues on the liver and its disorders in the critically ill.
OBJECTIVE
Vasopressin and terlipressin, a long-acting V1a analogue, are increasingly used in intensive care. The main clinical indications are the treatment of patients with septic shock and of patients with cirrhosis, who develop variceal bleeding, the hepatorenal syndrome or both. In this review, we summarize the effects of these drugs on splanchnic hemodynamics and organ function.


RESULTS
A recent systematic meta-analysis of randomized trials suggests that terlipressin may improve renal function in hepatorenal syndrome and thereby reduce mortality by 34%. Moreover, a recent study reported that association of terlipressin and albumin was more effective than terlipressin alone. In patients with variceal bleeding, the bleeding control is significantly improved by early administration of terlipressin. The place of vasopressin in the treatment of patients with septic shock is still discussed, but compared with norepinephrine, vasopressin showed at least an equal efficacy.


CONCLUSIONS
The use of vasopressin and its synthetic analogues has shown beneficial effects in the management of patients with cirrhosis, especially in the context of variceal bleeding, the hepatorenal syndrome or both. In both cases, the use of terlipressin improved survival. Therefore, in these clinical indications, terlipressin is a part of recommendations. The role of vasopressin in patients with septic shock remains to be precisely evaluated.
Asfar
Pierre
P
Laboratoire HIFIH, UPRES EA 3859, IFR 132, Université d'Angers, PRES UNAM, France. piasfar@chu-angers.fr
Radermacher
Peter
P
Calès
Paul
P
Oberti
Frédéric
F
D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006439:Hemodynamics; D006530:Hepatorenal Syndrome / Q000139:chemically induced; D006801:Humans; D007362:Intensive Care Units; D008099:Liver / Q000187:drug effects*; D008103:Liver Cirrhosis / Q000139:chemically induced; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology; D012307:Risk Factors; D012772:Shock, Septic / Q000139:chemically induced; D000077585:Terlipressin; D014648:Varicose Veins / Q000139:chemically induced; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000494:pharmacology*; D014667:Vasopressins / Q000009:adverse effects / Q000494:pharmacology*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D008236:Lypressin; D000077585:Terlipressin