Noradrenaline vs. terlipressin in the treatment of hepatorenal syndrome: a randomized study.
OBJECTIVE
Various vasoconstrictors are useful in the management of hepatorenal syndrome (HRS). Terlipressin is the drug of choice; however, it is expensive. In this study, we evaluated safety and efficacy of terlipressin and noradrenaline in the treatment of HRS.


METHODS
Forty-six patients with HRS type 1 were managed with terlipressin (group A, N=23) or noradrenaline (Group B, N=23) with albumin in a randomized controlled trial at a tertiary center.


RESULTS
HRS reversal could be achieved in 9 (39.1%) patients in group A and 10 (43.4%) patients in group B (p=0.764). Univariate analysis showed baseline Child Turcotte Pugh score (CTP), model of end stage liver disease (MELD), urine output on day 1(D1), albumin, and mean arterial pressure (MAP) were associated with response. However, on multivariate analysis only CTP score was associated with response. Fourteen patients in group A and 12 in group B died at day 15 (p>0.05). Noradrenaline was less expensive than terlipressin (p<0.05). No major adverse effects were seen.


CONCLUSIONS
The results of this randomized study suggest that noradrenaline is as safe and effective as terlipressin, but less expensive in the treatment of HRS and baseline CTP score is predictive of response.
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. virendrasingh100@hotmail.com
Virendra
V
Singh
Souvik
S
Ghosh
Baljinder
B
Singh
Pradeep
P
Kumar
Navneet
N
Sharma
Ashish
A
Bhalla
A K
AK
Sharma
N S
NS
Choudhary
Yogesh
Y
Chawla
C K
CK
Nain
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006530:Hepatorenal Syndrome / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D000077585:Terlipressin
D008236:Lypressin; D000077585:Terlipressin; D009638:Norepinephrine