Format

Send to

Choose Destination
J Hepatol. 2014 May;60(5):955-61. doi: 10.1016/j.jhep.2013.12.032. Epub 2014 Jan 18.

Terlipressin and albumin for type-1 hepatorenal syndrome associated with sepsis.

Author information

1
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain.
2
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain; Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
3
Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, University of Turin, Turin, Italy.
4
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Liver Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
5
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Hospital Parc Taulí, Sabadell, Spain.
6
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain; Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain. Electronic address: pgines@clinic.ub.es.

Erratum in

  • J Hepatol. 2014 Aug;61(2):456.

Abstract

BACKGROUND & AIMS:

Terlipressin and albumin is the standard of care for classical type-1 hepatorenal syndrome (HRS) not associated with active infections. However, there is no information on efficacy and safety of this treatment in patients with type-1 HRS associated with sepsis. Study aim was to investigate the effects of early treatment with terlipressin and albumin on circulatory and kidney function in patients with type-1 HRS and sepsis and assess factors predictive of response to therapy.

METHODS:

Prospective study in 18 consecutive patients with type-1 HRS associated with sepsis.

RESULTS:

Treatment was associated with marked improvement in arterial pressure and suppression of the high levels of plasma renin activity and norepinephrine. Response to therapy (serum creatinine <1.5mg/dl) was achieved in 12/18 patients (67%) and was associated with improved 3-month survival compared to patients without response. Non-responders had significantly lower baseline heart rate, poor liver function tests, slightly higher serum creatinine, and higher Child-Pugh and MELD scores compared to responders. Interestingly, non-responders had higher values of CLIF-SOFA score compared to responders (14±3 vs. 8±1, respectively p<0.001), indicating greater severity of acute-on-chronic liver failure (ACLF). A CLIF-SOFA score ⩾11 had 92% sensitivity and 100% specificity in predicting no response to therapy. No significant differences were observed between responders and non-responders in baseline urinary kidney biomarkers. Treatment was safe and no patient required withdrawal of terlipressin.

CONCLUSIONS:

Early treatment with terlipressin and albumin in patients with type-1 HRS associated with sepsis is effective and safe. Patients with associated severe ACLF are unlikely to respond to treatment.

KEYWORDS:

Acute-on-chronic liver failure; Cirrhosis; Hepatorenal syndrome; Terlipressin

PMID:
24447876
DOI:
10.1016/j.jhep.2013.12.032
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center