title: Noradrenaline vs terlipressin in the treatment of type 2 hepatorenal syndrome: a randomized pilot study.
abstract: BACKGROUND
  Various vasoconstrictors have shown promising results in the management of type 1 hepatorenal syndrome (HRS). However, there are very few studies on vasopressors in the management of type 2 HRS. Terlipressin has been used commonly; however, it is costly and not available in some countries. In this study, we evaluated the safety and efficacy of terlipressin and noradrenaline in the treatment of type 2 HRS.
  
  
  METHODS
  Forty-six patients with type 2 HRS were managed with terlipressin (group A, N = 23) or noradrenaline (Group B, N = 23) with albumin in a randomized controlled trial at a tertiary centre.
  
  
  RESULTS
  HRS reversal could be achieved in 17(73.9%) patients in group A as well as in group B (P = 1.0). Univariate analysis showed that the baseline model of end-stage liver disease score, urine output, urinary sodium, serum creatinine and mean arterial pressure were associated with response. However, in multivariate analysis only baseline serum creatinine, urine output and urinary sodium were associated with the response. Eight patients in group A and 9 in group B died within 90 days of follow-up (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 terlipressin and noradrenaline are safe and effective in the treatment of type 2 HRS and baseline serum creatinine, urine output and urinary sodium are predictive of response. Noradrenaline is less expensive than terlipressin in the treatment of type 2 HRS (ClinicalTrials.gov, Number NCT01637454).
authors.affiliation: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Saubhik
authors.initials: S
authors.lastname: Ghosh
authors.forename: Narendra S
authors.initials: NS
authors.lastname: Choudhary
authors.forename: Arun K
authors.initials: AK
authors.lastname: Sharma
authors.forename: Baljinder
authors.initials: B
authors.lastname: Singh
authors.forename: Pradeep
authors.initials: P
authors.lastname: Kumar
authors.forename: Ritesh
authors.initials: R
authors.lastname: Agarwal
authors.forename: Navneet
authors.initials: N
authors.lastname: Sharma
authors.forename: Ashish
authors.initials: A
authors.lastname: Bhalla
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Chawla
authors.forename: Virendra
authors.initials: V
authors.lastname: Singh
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D012964:Sodium / Q000652:urine; D000077585:Terlipressin; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014554:Urination; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D012964:Sodium; D003404:Creatinine; D009638:Norepinephrine
keywords: Ascites; renal dysfunction; splanchnic vasodilatation; vasopressor