Safety And Efficacy of Terlipressin In Acute-On-Chronic Liver Failure With Acute Kidney Injury – A Prospective Cohort Study

Abstract Background: Terlipressin with albumin, the recommended treatment for hepatorenal syndrome-acute kidney injury (HRS-AKI), is associated with adverse events. Furthermore, the course of AKI in patients with acute-on-chronic liver failure (ACLF) is unknown. We aimed to analyze the safety and efficacy of terlipressin infusion and AKI course in patients with ACLF.Methods: We prospectively enrolled consecutive adult patients with ACLF with HRS-AKI (satisfying either EASL or APASL criteria) treated with terlipressin infusion between 14 October 2019 and 24 July 2020. The objectives were to assess the incidence of adverse events, response to terlipressin, and differential treatment response in EASL and APASL subgroups. Results: Of the 116 patients, 51 satisfied EASL criteria, and 65 satisfied APASL criteria. Twenty-one percent of patients developed adverse effects. Only 1/3rd of patients who developed adverse events were alive at day 90. Sixty-five percent of the patients responded to terlipressin. Nearly 22% developed recurrence of HRS, and 5.2% progressed to HRS-chronic kidney disease. Response to terlipressin was higher in EASL (78.43%) than APASL subgroup (53.84%;P=0.006). Terlipressin non-response predicted mortality in EASL (aHR,6.35[1.15-35.13];P=0.03) and APASL subgroups (aHR,3.07[1.47-6.4];P=0.003).Conclusion: ACLF patients who develop terlipressin adverse events have dismal prognoses. Terlipressin non-response predicts mortality in patients with ACLF and HRS-AKI.

Download Full-text

Terlipressin for Hepatorenal Syndrome-Acute Kidney Injury in Acute-On-Chronic Liver Failure: A Single-Center Retrospective Cohort Study

10.21203/rs.3.rs-143931/v1 ◽

2021 ◽

Author(s):

songtao liu ◽

Qinghua Meng ◽

Zhongjie Hu ◽

Jun Lu ◽

Mei Liu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Liver Failure ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Chronic Liver ◽

High Rate ◽

Reversal Rate ◽

Therapeutic Effects ◽

Chronic Liver Failure ◽

Reversal Time

Abstract Objectives: Patients with hepatorenal syndrome-acute kidney injury (HRS-AKI) based on acute-on-chronic liver failure (ACLF) have a high rate of mortality. Terlipressin combined with albumin is the first line therapy for HRS-AKI in cirrhosis, however, whether it is more effective than albumin alone in ACLF is unclear. We aimed to analyze therapeutic effects of terlipressin in these patients. Methods: A retrospective study was conducted on patients with HRS-AKI based on ACLF at Beijing You’an Hospital between October 2010 and October 2019. The primary endpoint was a reversal rate of HRS-AKI, which was defined as serum creatinine (sCr) reduced to within 0.3 mg/dL of baseline. The secondary endpoints included a reversal rate of HRS in patients with sCr<1.5mg/dL and 28-day survival. Results: 221 of 755 patients meet inclusion criteria. 113 cases were treated with terlipressin plus albumin (TA group), whereas 108 cases with albumin alone (AA group). The reversal rate of HRS-AKI in TA group was higher compared to in AA group (35.39% vs 23.15%, P = 0.046). Additionally, reversal time in TA group was 8.18 ± 4.39 days, compared to 11.29 ± 3.67 days in AA group ( P = 0.005). In patients with sCr < 1.5mg/dL, reversal rate of HRS-AKI in TA group was 41.46% (17/47) compared to 19.61% (10/51) in AA group (P = 0.067). Furthermore, reversal time in TA group was 8.12±5.75 days, compared to 9.40±2.67 days in AA group (P=0.117). Notably, 28-day overall survival and transplantation-free survival in TA group was better than AA group (P < 0.001).Conclusions: Terlipressin combined albumin was effective for HRS-AKI in ACLF. Combination therapy tends to be more beneficial for patients with sCr level <1.5 mg/dL.

Download Full-text