Clinical course, predictive factors and prognosis in patients with cirrhosis and type 1 hepatorenal syndrome treated with Terlipressin: A retrospective analysis

Authors

  • Isabelle Colle,

    Corresponding author
    1. Laboratoire d’Hémodynamique Splanchnique et de Biologie Vasculaire, Institut National de la Santé et de la Recherge Médicale U-481,
    2. Service d’Hépatologie and
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  • François Durand,

    1. Laboratoire d’Hémodynamique Splanchnique et de Biologie Vasculaire, Institut National de la Santé et de la Recherge Médicale U-481,
    2. Service d’Hépatologie and
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  • Fabienne Pessione,

    1. Unité de Traitement Ambulatoire de Maladie Alcoolique, Hôpital Beaujon, Clichy, France
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  • Emmanuel Rassiat,

    1. Laboratoire d’Hémodynamique Splanchnique et de Biologie Vasculaire, Institut National de la Santé et de la Recherge Médicale U-481,
    2. Service d’Hépatologie and
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  • Jacques Bernuau,

    1. Laboratoire d’Hémodynamique Splanchnique et de Biologie Vasculaire, Institut National de la Santé et de la Recherge Médicale U-481,
    2. Service d’Hépatologie and
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  • Eric Barrière,

    1. Laboratoire d’Hémodynamique Splanchnique et de Biologie Vasculaire, Institut National de la Santé et de la Recherge Médicale U-481,
    2. Service d’Hépatologie and
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  • Didier Lebrec,

    1. Laboratoire d’Hémodynamique Splanchnique et de Biologie Vasculaire, Institut National de la Santé et de la Recherge Médicale U-481,
    2. Service d’Hépatologie and
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  • Dominique-Charles Valla,

    1. Laboratoire d’Hémodynamique Splanchnique et de Biologie Vasculaire, Institut National de la Santé et de la Recherge Médicale U-481,
    2. Service d’Hépatologie and
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  • Richard Moreau

    1. Laboratoire d’Hémodynamique Splanchnique et de Biologie Vasculaire, Institut National de la Santé et de la Recherge Médicale U-481,
    2. Service d’Hépatologie and
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Dr I Colle, Department of Hepato-Gastroenterologie, University Hospital of Ghent (UZ-Ghent), De Pintelaan 185, 9000 Ghent, Belgium. Email: Isabelle.Colle@rug.ac.be

Abstract

Abstract Background and Aim: Terlipressin has been proposed to treat renal failure in patients with type 1 hepatorenal syndrome (HRS). However, the predictive factors for improved renal function and survival are unknown in patients with type 1 HRS treated with terlipressin. The aim of the present retrospective study was to investigate the predictive factors and prognosis of patients with type 1 HRS treated with terlipressin.

Methods: The clinical charts of 18 consecutive patients with cirrhosis and type 1 HRS treated with terlipressin were studied. The predictive factors for improved renal function and survival were identified using univariate analyses.

Results: Improved renal function, indicated by a significant decrease in serum creatinine (61 ± 4%), occurred in 11 (60%) patients. The only predictive factor for improved renal function was a Child–Pugh's score ≤13 at the time of diagnosis of HRS (P = 0.02). Fifteen patients (83%) died at 45 days and the median survival was 24 days. Of the three patients who survived, two underwent successful orthotopic liver transplantation. Three predictive factors for survival were identified: absence of a precipitating factor for HRS (P = 0.012); improved renal function during terlipressin therapy (P = 0.05); and a dose of terlipressin ≥3 mg/day (P = 0.04).

Conclusions: In patients with type 1 HRS treated with terlipressin, patients with improved renal function had less severe cirrhosis (Child–Pugh >10 but ≤13) than patients without. The predictive factors for survival were the absence of a precipitating factor for HRS, the terlipressin-induced improvement in renal function and a dose of terlipressin of at least 3 mg/day. These findings suggest that a randomized controlled trial investigating the effect of terlipressin on survival in patients with type 1 HRS should be performed.

© 2002 Blackwell Publishing Asia Pty Ltd

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