title: Survival benefits of terlipressin and non-responder state in hepatorenal syndrome: a meta-analysis.
abstract: OBJECTIVE
  Terlipressin improves renal function in hepatorenal syndrome (HRS) is a known fact. However the reason for lack of its long-term survival benefits despite improvement in renal function remains unclear. The aim of this study was to analyze the survival benefits of terlipressin in HRS and to address the issue of non-responder state to terlipressin.
  
  
  METHODS
  Electronic databases and relevant articles were searched for all types of studies related to HRS and use of terlipressin in HRS. Reduction in all-cause mortality rate was the primary outcome measure. Reduction in mortality rate due to HRS and other causes of death were also analyzed.
  
  
  RESULTS
  With total 377 patients analyzed from eight eligible studies; terlipressin reduced all-cause mortality rate by 15% (Risk Difference: -0.15%, 95% CI:-0.26 to -0.03). Reduction in the mortality rate due to HRS at three months was 9% (Risk Difference:-0.09%, 95% CI:-0.18 to 0.00).
  
  
  CONCLUSIONS
  Terlipressin has long term survival benefits perhaps at least up to three months but only with HRS as a cause of death not for other causes of death. Benefits and role of antioxidants like N- Acetylcysteine (NAC) in non-responder patients' needs to be studied further. Long-term use of low dose terlipressin (<4 mg/d) plus albumin and addition of antioxidant NAC to this regimen may help in improving both HRS reversal rate and survival rate in non-responders to terlipressin.
authors.affiliation: Department of Pharmacology, SDM College of Medical Sciences and Hospital, Davangere, Karnataka, India.
authors.forename: Sharanabasayyaswamy B
authors.initials: SB
authors.lastname: Hiremath
authors.forename: L D
authors.initials: LD
authors.lastname: Srinivas
mesh_terms: D004305:Dose-Response Relationship, Drug; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015996:Survival Rate; D000077585:Terlipressin; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin
keywords: Hepatorenal syndrome; N-Acetylcysteine; albumin; terlipressin
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