title: Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.
abstract: BACKGROUND
  Hepatorenal syndrome (HRS) is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. Norepinephrine could be an effective alternative. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of norepinephrine compared to terlipressin in the management of HRS.
  
  
  METHODS
  We searched the Medline, Embase, Scopus, CENTRAL, Lilacs and Scielo databases for randomized trials of norepinephrine and terlipressin in the treatment of HRS up to January 2014. Two reviewers collected data and assessed the outcomes and risk of bias. The primary outcome was the reversal of HRS. Secondary outcomes were mortality, recurrence of HRS and adverse events.
  
  
  RESULTS
  Four studies comprising 154 patients were included. All trials were considered to be at overall high risk of bias. There was no difference in the reversal of HRS (RR = 0.97, 95% CI = 0.76 to 1.23), mortality at 30 days (RR = 0.89, 95% CI = 0.68 to 1.17) and recurrence of HRS (RR = 0.72; 95% CI = 0.36 to 1.45) between norepinephrine and terlipressin. Adverse events were less common with norepinephrine (RR = 0.36, 95% CI = 0.15 to 0.83).
  
  
  CONCLUSIONS
  Norepinephrine seems to be an attractive alternative to terlipressin in the treatment of HRS and is associated with less adverse events. However, these findings are based on data extracted from only four small studies.
authors.affiliation: Intensive Care Unit, Department of Gastroenterology, University of Sao Paulo. Sao Paulo, SP, Brazil.
authors.forename: Antonio Paulo
authors.initials: AP
authors.lastname: Nassar Junior
authors.affiliation: Discipline of Gastroenterology, Department of Gastroenterology. University of Sao Paulo. Sao Paulo, SP, Brazil.
authors.forename: Alberto Queiroz
authors.initials: AQ
authors.lastname: Farias
authors.affiliation: Liver and Gastrointestinal Transplant Division, Department of Gastroenterology. University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Luiz Augusto Carneiro
authors.initials: LA
authors.lastname: D' Albuquerque
authors.affiliation: Discipline of Gastroenterology, Department of Gastroenterology. University of Sao Paulo. Sao Paulo, SP, Brazil.
authors.forename: Flair José
authors.initials: FJ
authors.lastname: Carrilho
authors.affiliation: Intensive Care Unit, Department of Gastroenterology, University of Sao Paulo. Sao Paulo, SP, Brazil.
authors.forename: Luiz Marcelo Sá
authors.initials: LM
authors.lastname: Malbouisson
mesh_terms: D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D009638:Norepinephrine / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D009638:Norepinephrine