title: Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics.
abstract: OBJECTIVE
  Administration of terlipressin plus albumin is effective in reversing type 1 HRS as compared to albumin alone. However, only about 1/3 of patients respond to treatment, therefore, predictors of response and survival would help identify the patients most likely to benefit from treatment.
  
  
  METHODS
  We analyzed our controlled trial of terlipressin vs. placebo (Gastroenterology 2008;134:1360) to define factors predictive of a response and to correlate hemodynamic changes to changes in renal function.
  
  
  RESULTS
  Single variant analysis showed treatment with terlipressin, MELD score, and baseline serum creatinine to be predictive of HRS reversal. Alcoholic hepatitis, baseline serum creatinine, and MELD score were predictive of survival. When treatment was not considered as a variable, only baseline serum creatinine predicted HRS reversal. Baseline serum creatinine, presence of alcoholic hepatitis, and Child-Pugh score were also predictive of survival on multivariate analysis. The rise in mean arterial pressure (MAP) following terlipressin administration was not predictive of HRS reversal. However, in those who achieved HRS reversal from terlipressin, there was a significant rise in MAP from beginning to end of treatment.
  
  
  CONCLUSIONS
  The most consistent predictor of response to terlipressin and of survival is the baseline serum creatinine. Patients most likely to benefit from terlipressin have earlier onset renal failure (i.e. serum creatinine <5.0mg/dl). A sustained rise in MAP is required for HRS reversal. As MAP is a surrogate marker for the hyperdynamic circulation, it is only with improvement in the hyperdynamic circulation that HRS reversal is observed.
authors.affiliation: Dept. of Medicine, University of Arizona, College of Medicine, Tucson, AZ, United States. tboyer@deptofmed.arizona.edu
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Boyer
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Garcia-Tsao
authors.forename: Andres
authors.initials: A
authors.lastname: Blei
authors.forename: Daniel
authors.initials: D
authors.lastname: Carl
authors.forename: Alice S
authors.initials: AS
authors.lastname: Bexon
authors.forename: Peter
authors.initials: P
authors.lastname: Teuber
mesh_terms: D000328:Adult; D000418:Albumins / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006530:Hepatorenal Syndrome / Q000097:blood / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D011446:Prospective Studies; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000418:Albumins; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D003404:Creatinine