Terlipressin may reverse HRS in patients with systemic inflammatory response syndrome
Terlipressin may produce more favourable outcomes in patients with systemic inflammatory response syndrome (SIRS), improving renal function and reversing hepatorenal syndrome (HRS) compared with albumin plus placebo, a retrospective study suggests.
Researchers reviewed the medical records of 198 patients with HRS type 1 who participated in a trial evaluating the effects of terlipressin (1 mg every 6 hours) vs placebo with concomitant albumin. Two patient groups were identified, including those with two or more criteria for SIRS and those with with less than two criteria for SIRS (controls).
The main endpoints were HRS reversal (serum creatinine level decreasing to ≤1.5 mg/dL), confirmed HRS reversal (two serum creatinine levels ≤1.5 mg/dL; ≥48 hours apart) and survival for 90 days after treatment.
The two patients groups showed similar baseline characteristics, with the exception of SIRS patients having slightly higher white blood cell counts and heart rates and slightly lower serum bicarbonate levels compared with controls.
HRS reversal occurred in 42.9 percent of SIRS patients who received terlipressin (12/28) vs 6.7 percent of those who received placebo (2/30; p=0.0018).
The proportion of patients with confirmed HRS reversal was 32.1 percent in the terlipressin group vs 3.3 percent in the placebo group (p=0.0048). Those who survived for 90 days without a transplant was 46.4 vs 23.3 percent, respectively, (p=0.076).
HRS is characterized by portal hypertension with impaired kidney perfusion by vasoconstrictor endogenous mediators in patients with liver cirrhosis, acute liver failure or alcoholic hepatitis. While the condition may be reversed, HRS poses a life-threatening risk, requiring prompt diagnosis and rapid treatment. [Gastroenterol Res Pract 2015;457613]
Type I HRS is particularly associated with poor prognosis. This subtype develops rapidly, as may be indicated by the doubling of the serum creatinine concentration within 2 weeks. Patients with this HRS type have a mortality of 50 percent after 2 weeks of diagnosis, increasing to 100 percent within months.