Gastroenterology

Gastroenterology

Volume 122, Issue 4, April 2002, Pages 923-930
Gastroenterology

Clinical Research
Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: A retrospective multicenter study,☆☆

https://doi.org/10.1053/gast.2002.32364Get rights and content

Abstract

Background & Aims: Type 1 hepatorenal syndrome (HRS) is a severe complication of cirrhosis associated with a short median survival time (<2 weeks). Although the administration of terlipressin improves renal function, its effect on survival is unknown. This study investigated predictive factors of survival in patients with type 1 HRS treated with terlipressin. Methods: Ninety-nine patients with type 1 HRS treated with terlipressin in 24 centers were retrospectively studied. Terlipressin-induced improved renal function was defined as a decrease in serum creatinine value to <130 μmol/L or a decrease of at least 20% at the end of treatment. Results: At inclusion, the Child–Pugh score was 11.8 ± 1.6 (mean ± SD). Terlipressin (3.2 ± 1.3 mg/day) was administered for 11 ± 12 days. Renal function improved in 58% of patients (serum creatinine decreased by 46% ± 17% from 272 ± 114 μmol/L). Median survival time was 21 days. Survival rate was 40% at 1 month. Multivariate analysis showed that improved renal function and Child–Pugh score ≤11 at inclusion were independent predictive factors of survival (P < 0.0001 and 0.02, respectively). Thirteen patients underwent liver transplantation (92 ± 95 days after HRS onset), 10 of whom had received terlipressin and had had improved renal function. Conclusions: This retrospective uncontrolled study shows that in patients with type 1 HRS, terlipressin-induced improved renal function is associated with an increase in survival. Thus, a randomized trial investigating the effect of terlipressin on survival in patients with type 1 HRS should be performed.

GASTROENTEROLOGY 2002;122:923-930

Section snippets

Patients

This retrospective study included 99 patients with cirrhosis and type 1 HRS treated with terlipressin (Glypressine; Laboratoire Ferring SAS, Gentilly, France) admitted between April 1996 and April 2000 to 24 centers. All patients with HRS who had been treated with terlipressin in these centers were evaluated. To be included, patients were required to meet the following criteria: older than 18 years; diagnosis of HRS according to the International Ascites Club diagnosis criteria (i.e., low

Results

Fifty-five patients were enrolled in 5 large centers, and 44 patients were enrolled in 19 small centers. In 10 centers (including the 5 large centers), information was available on all the causes of renal failure in patients with cirrhosis admitted during the study period. In these 10 centers, 71 of 423 (17%) patients with cirrhosis and renal failure met the inclusion criteria. Three hundred fifty-two of 423 patients were excluded because of acute renal failure sensitive to plasma volume

Discussion

Although this was a retrospective study, it is the first investigation of the clinical course, predictive factors of improved renal function, and survival in a large series of patients with cirrhosis and type 1 HRS treated with terlipressin. At diagnosis of type 1 HRS before treatment, patients had severe cirrhosis, i.e., an increased Child–Pugh score and arterial hypotension.

In this study, the mean dose of terlipressin was 3 mg, and the mean duration of administration was 11 days. Terlipressin

Acknowledgements

The authors thank Patrick Blandin and Alain Truskolaski for their expert assistance.

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Address requests for reprints to: Richard Moreau, M.D., INSERM U-481, Hôpital Beaujon, 92118 Clichy, France. e-mail: [email protected]; fax: (33) 1-47-30-17-11.

☆☆

The study was supported by Ferring SAS (Gentilly, France).

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