title: Hepatorenal syndrome:Response to terlipressin and albumin and its determinants.
abstract: OBJECTIVE
  To determine the efficacy of terlipressin and albumin in improving renal functions in patient with hepatorenal syndrome (HRS) and to identify factors determinant of better response.
  
  
  METHODS
  In this quasi experimental interventional study patients of liver cirrhosis and ascites with HRS type I were treated with intravenous albumin and incremental dosage of terlipressin based on response with maximum dose of 12mg/day. Decline of creatinine below 1.5mg/dl was defined as complete response. Factors predictive of response to therapy were determined via linear regression analysis.
  
  
  RESULTS
  Twenty four patients were included with male to female ratio 3.8/1(19/5) and mean age 53.3 (±10.06). Complete response to terlipressin/albumin was seen in 14 (58.3%)patients, seven (29.2%) achieved partial response with > 25% creatinine decline while three (12.5%) had no response. Lower serum creatinine at diagnosis (P value 0.003), absence of hyperkalemia (p value 0.005) and absence of portal vein thrombosis (p value 0.05) are associated with response to treatment in HRS. Baseline serum creatinine (p value 0.003) was independent predictor of response to therapy in multivariate analysis.
  
  
  CONCLUSIONS
  Terlipressin and albumin is an effective treatment for HRS type I. Patients with lower baseline serum creatinine are more likely to respond to this therapy.
authors.affiliation: Dr. Shahid Sarwar, FCPS (Medicine) FCPS (Gastroenterology). Associate Professor Gujranwala Medical College, Consultant Gastroenterologist, Doctors Hospital & Medical Center, Lahore, Pakistan.
authors.forename: Shahid
authors.initials: S
authors.lastname: Sarwar
authors.affiliation: Anwaar A. Khan, MACP, FACG, FRCP, AGAF, FCPSEx- Dean and Professor of Gastroenterology, ShaikhZayed Post Graduate Medical Institute, Consultant Gastroenterologist, Doctors Hospital & Medical Center, Lahore, Pakistan.
authors.forename: Anwaar A
authors.initials: AA
authors.lastname: Khan
keywords: Cirrhosis; Hepatorenal syndrome (HRS); Terlipressin; intravenous albumin