Noradrenaline or terlipressin for hepatorenal syndrome?
Hepatorenal syndrome is a condition associated with very high mortality that may be reverted in some cases with vasoconstrictors. Terlipressin has generally been considered standard treatment, but noradrenaline has been postulated as alternative. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews including four pertinent randomized controlled trials. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded noradrenaline and terlipressin probably have similar effects on reverting hepatorrenal syndrome and decreasing mortality, but noradrenaline is associated with less adverse effects, and has lower costs.
Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile; Proyecto Epistemonikos. Address: Facultad de Medicina, Pontificia Universidad Católica de Chile, Lira 63, Santiago Centro, Chile. Email: radagabriel@epistemonikos.org.
Pilar
P
Celis
Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile; Programa de Salud Basada en Evidencia, Facultad de Medicina, Pontificia Universidad Católica de Chile; GRADE working group; The Cochrane Collaboration; Proyecto Epistemonikos.
Gabriel
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Rada
D016527:Drug Costs; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D009638:Norepinephrine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D009638:Norepinephrine