Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov;16(11):1792-1800.e3.
doi: 10.1016/j.cgh.2018.01.035. Epub 2018 Jan 31.

Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome

Salvatore Piano  1 , Hartmut H Schmidt  2 , Xavier Ariza  3 , Alex Amoros  4 , Antonietta Romano  1 , Anna Hüsing-Kabar  2 , Elsa Solà  3 , Alexander Gerbes  5 , Mauro Bernardi  6 , Carlo Alessandria  7 , Bernhard Scheiner  8 , Marta Tonon  1 , Miriam Maschmeier  2 , Cristina Solè  3 , Jonel Trebicka  9 , Thierry Gustot  10 , Frederik Nevens  11 , Vicente Arroyo  4 , Pere Gines  12 , Paolo Angeli  13 ; EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure (EF Clif)
Affiliations

Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome

Salvatore Piano et al. Clin Gastroenterol Hepatol. 2018 Nov.

Abstract

Background & aims: Type 1 hepatorenal syndrome (HRS) is the most high-risk type of renal failure in patients with cirrhosis. Terlipressin and albumin are effective treatments for type 1 HRS. However, the effects of acute on chronic liver failure (ACLF) grade on response to treatment are not clear. We aimed to identify factors associated with response to treatment with terlipressin and albumin in patients with type 1 HRS (reduction in serum level of creatinine to below 1.5 mg/dL at the end of treatment) and factors associated with death within 90 days of HRS diagnosis (90-day mortality).

Methods: We performed a retrospective analysis of 4 different cohorts of consecutive patients with HRS treated with terlipressin and albumin from February 2007 through January 2016 at medical centers in Europe (total, 298 patients). We analyzed demographic, clinical, and laboratory data collected before and during treatment; patients were followed until death, liver transplantation, or 90 days after HRS diagnosis.

Results: Response to treatment was observed in 53% of patients. Of patients with grade 1 ACLF, 60% responded to treatment; among those with grade 2 ACLF, 48% responded, and among those with grade 3 ACLF, 29% responded (P < .001 for comparison between grades). In multivariate analysis, baseline serum level of creatinine (odds ratio, 0.23; P = .001) and ACLF grade (odds ratio, 0.63; P = .01) were independently associated with response to treatment. Patient age (hazard ratio [HR], 1.05; P < .001), white blood cell count (HR, 1.51; P = .006), ACLF grade (HR, 2.06; P < .001), and no response to treatment (HR, 0.41; P < .001) associated with 90-day mortality.

Conclusion: In a retrospective analysis of data from 4 cohorts of patients treated for type 1 HRS, we found ACLF grade to be the largest determinant of response to terlipressin and albumin. ACLF grade affects survival independently of response to treatment. New therapeutic strategies should be developed for patients with type 1 HRS and extrarenal organ failure.

Keywords: Acute kidney Injury; Cirrhosis; Hepatorenal Syndrome; Liver Transplantation.

PubMed Disclaimer

Comment in

Publication types