title: No difference in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding and renal functional impairment.
abstract: OBJECTIVE
  To study the differences in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding (EVB) and renal functional impairment (RFI).
  
  
  METHODS
  The National Health Insurance Database, part of the Taiwan National Health Insurance Program, was used to enroll cirrhotic patients who had received endoscopic variceal ligation plus somatostatin or terlipressin for EVB and who were hospitalized between 1 January 2007 and 31 December 2010. The differences in mortality between the two vasoactive agents were compared and the risk factors for 30-day mortality because of EVB were identified.
  
  
  RESULTS
  A total of 2324 cirrhotic patients with EVB were enrolled. The 30-day mortality data showed no significant differences between the somatostatin and the terlipressin groups (P=0.232). The risk of 30-day mortality was significantly higher in male patients [hazard ratio (HR): 1.50, P=0.002] and patients with hepatic encephalopathy (HR: 1.82, P<0.001), ascites (HR: 1.32, P=0.008), bacterial infections (HR: 2.10, P<0.001), hepatocellular carcinoma (HR: 2.09, P<0.001), and RFI (HR: 3.89, P<0.001). A subgroup analysis of cirrhotic patients with RFI was carried out. The overall 30-day mortality was higher in patients treated with somatostatin than in those treated with terlipressin (52.6 vs. 42.3%), but the difference failed to reach significance (adjust HR: 1.49, 95% confidence interval: 0.94-2.37, P=0.091).
  
  
  CONCLUSIONS
  RFI was the most important risk factor for 30-day mortality in EVB patients. Terlipressin and somatostatin had similar effects on 30-day mortality in cirrhotic patients with EVB and RFI.
authors.affiliation: Departments of aInternal Medicine, Division of Gastroenterology bMedicine, Division of Infectious Disease, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi cSchool of Medicine, Tzuchi University, Hualien dDepartment of Mathematics, Tamkang University, Tamsui, Taiwan.
authors.forename: Tsung-Hsing
authors.initials: TH
authors.lastname: Hung
authors.forename: Chen-Chi
authors.initials: CC
authors.lastname: Tsai
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Tseng
authors.forename: Kuo-Chih
authors.initials: KC
authors.lastname: Tseng
authors.forename: Yu-Hsi
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Chih-Chun
authors.initials: CC
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004932:Esophageal and Gastric Varices / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013004:Somatostatin / Q000627:therapeutic use*; D013624:Taiwan / Q000453:epidemiology; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D013004:Somatostatin; D000077585:Terlipressin