Effect of different therapeutic modalities on systemic, renal, and hepatic hemodynamics and short-term outcomes in cirrhotic patients with spontaneous bacterial peritonitis.
BACKGROUND
Spontaneous bacterial peritonitis (SBP) is a major risk factor for hepatorenal syndrome. Albumin infusion has been shown to prevent renal impairment and reduce mortality in SBP. The study aimed to compare the effect of different therapeutic modalities on hemodynamics and short clinical outcomes in high-risk patients with SBP.


METHODS
Two hundred cirrhotic patients with SBP and bilirubin greater than 4 mg[Fraction Slash]dl or creatinine more than 1 mg[Fraction Slash]dl were enrolled. Patients were randomized to receive albumin, terlipressin, low-dose albumin plus terlipressin, or midodrine. Systemic, renal, and hepatic hemodynamics were estimated at baseline, 3, and 10 days of treatment. Renal impairment was diagnosed when the blood urea nitrogen or serum creatinine levels increased by more than 50% of the pretreatment value.


RESULTS
SBP resolved in most of patients in all groups (P>0.05). Cardiac output and portal flow decreased, whereas systemic vascular resistance increased significantly in terlipressin and albumin plus terlipressin groups compared with the albumin group after 3 and 10 days. After 10 days, plasma renin activity, renal, and hepatic arteries resistive index were significantly higher in the midodrine group compared with the albumin group. The midodrine group did not show any significant changes in the heart rate, mean arterial pressure, cardiac output, and portal blood flow compared with the albumin group after 3 or 10 days. There was no significant difference in renal impairment or mortality between any of the groups.


CONCLUSIONS
Terlipressin and low-dose albumin plus terlipressin could be used as a therapeutic alternative to standard-dose albumin in high-risk SBP patients.
Departments of aHepatology bClinical Biochemistry cDiagnostic Radiology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt.
Tary A
TA
Salman
Ahmed M
AM
Edrees
Hala H
HH
El-Said
Osama L
OL
El-Abd
Gasser I
GI
El-Azab
D000328:Adult; D001424:Bacterial Infections / Q000150:complications* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006530:Hepatorenal Syndrome / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008102:Liver Circulation / Q000187:drug effects*; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use; D010538:Peritonitis / Q000150:complications* / Q000503:physiopathology; D012079:Renal Circulation / Q000187:drug effects*; D012709:Serum Albumin / Q000627:therapeutic use; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D012709:Serum Albumin; D014662:Vasoconstrictor Agents; D008236:Lypressin; D008879:Midodrine; D000077585:Terlipressin