title: [Response to Terlipressin and albumin is associated with improved outcome in patients with cirrhosis and hepatorenal syndrome].
abstract: OBJECTIVE
  Hepatorenal syndrome (HRS) is a severe but potentially reversible complication in patients with cirrhosis. Untreated it is associated with a poor prognosis. Several randomized controlled trials (RCT) demonstrated that treatment with terlipressin and albumin improves renal function. However the effect on overall survival is unclear. Aim of the study was to gain further insight into the effect of terlipressin treatment in patients with HRS on renal function, overall survival and survival without liver transplantation or renal replacement.
  
  
  METHODS
  All patients presenting with HRS and treated with terlipressin in our tertiary referral liver and transplantation center between April 2013 and April 2014 were included. Clinically relevant parameters such as response to therapy, overall survival and transplant- and renal-replacement-free-survival were prospectively investigated.
  
  
  RESULTS
  Overall 57 patients were prospectively followed over a median of 65 days. In the majority of patients cirrhosis was in an advanced stage (Child-Pugh C: 46; 81%). Median cumulative terlipressin dosage and treatment duration were 20 mg and 5 days, respectively. Complete or partial response to terlipressin with recovery from HRS was observed in 20 and 3 out of 57 patients (51%; 5%). Median overall survival was significantly better in patients with response to terlipressin than in patients with non-response (167 vs. 27 days; p > 0.0001), as well as median survival free of liver transplantation and renal-replacement-therapy (81 vs. 4 days; p > 0.0001). In uni- and multivariate analysis, non-response was associated with a high baseline serum-bilirubin-concentration.
  
  
  CONCLUSIONS
  Terlipressin in combination with albumin is effective in the majority of patients with HRS. Response to therapy is associated with improved survival.
authors.affiliation: 1. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
authors.forename: Marc
authors.initials: M
authors.lastname: Nguyen-Tat
authors.affiliation: 1. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
authors.forename: Esther
authors.initials: E
authors.lastname: Götz
authors.affiliation: Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin Mainz.
authors.forename: Peter
authors.initials: P
authors.lastname: Scholz-Kreisel
authors.affiliation: 1. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
authors.forename: Juliane
authors.initials: J
authors.lastname: Ahrens
authors.affiliation: 1. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
authors.forename: Visvakanth
authors.initials: V
authors.lastname: Sivanathan
authors.affiliation: 1. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
authors.forename: Jörn
authors.initials: J
authors.lastname: Schattenberg
authors.affiliation: Innere Medizin 2, Gastroenterologie, Hepatologie und Endokrinologie, Dr. Horst Schmidt Klinik (HSK), Wiesbaden.
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Rey
authors.affiliation: 1. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
authors.forename: Marcus-Alexander
authors.initials: MA
authors.lastname: Wörns
authors.affiliation: 1. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.affiliation: 1. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
authors.forename: Jens U
authors.initials: JU
authors.lastname: Marquardt
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006530:Hepatorenal Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000188:drug therapy*; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D000077585:Terlipressin; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D000959:Antihypertensive Agents; D008236:Lypressin; D000077585:Terlipressin