Real-World Use of Terlipressin in Cirrhosis and Acute Kidney Injury: Frequent Use Beyond Hepatorenal Syndrome.
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Ma Ann T, Juanola Adrià, Patidar Kavish R, Barone Anna, Incicco Simone, Kulkarni Anand V, Verma Nipun, Lange Christian M, Xie Qing, Alessandria Carlo, Cerda Reyes Eira, Maiwall Rakhi, Kim Jeong Han, Marciano Sebastián, Farias Alberto Queiroz, Toledo Claudio, Nardelli Silvia, Vorobioff Julio D, Roblero Juan Pablo, Thévenot Thierry, Papp Maria, Maan Raoel, Solé Cristina, Cordova-Gallardo Jacqueline, Simonetto Douglas A, Fouad Yasser, Balcar Lorenz, Raevens Sarah, Nabilou Puria, Caraceni Paolo, Merli Manuela, Presa José, Laleman Wim, Krag Aleksander, Bruns Tony, Pereira Gustavo, Mattos Angelo Z, Arab Juan Pablo, Wentworth Brian, Abdelkader Nadia Abdelaaty, Wong Yu Jun, Kim Sung-Eun, Roux Olivier, Takkenberg R Bart, Galante Antonio, Goncalves Luciana Lofego, Pyrsopoulos Nikolaos T, Pérez Hernández José Luis, Asrani Sumeet K, Torre Aldo, Díaz-Ferrer Javier, Orman Eric S, Perricone Giovanni, Gadano Adrian, Ivashkin Vladimir, Fassio Eduardo, Marino Mónica, Vargas Victor, Rabinowich Liane, Montes Pedro, Mohammed Abdulsemed, Carrera Enrique, Cabrera María Cecilia, Girala Marcos, Samant Hrishikesh, Madaleno Joao, Kim W Ray, Ferreira Carlos Noronha, Allegretti Andrew S, Sarin Shiv K, Ginès Pere, Angeli Paolo, Solà Elsa, Piano Salvatore, International Club of Ascites GLOBAL AKI team
Аннотация
METHODS: International prospective study including patients hospitalized for decompensated cirrhosis. This was a subgroup analysis of patients who received terlipressin to treat AKI. Primary outcome was AKI resolution. Secondary outcomes were respiratory failure and 28-day mortality.
RESULTS: Among 1456 patients with AKI, 243 (17%) received terlipressin. Terlipressin was predominantly administered as a continuous infusion (75%). The AKI phenotype was HRS-AKI in 50%, acute tubular necrosis (ATN) in 17%, hypovolemic in 25%, and other in 8%. AKI resolution occurred in 49% of the patients, and was lowest in ATN (29%), followed by HRS-AKI (51%) and hypovolemic (63%). ATN was independently associated with lack of AKI resolution (odds ratio, 2.77; 95% confidence interval, 1.24-6.54; P = .02). De novo respiratory failure occurred in 20% of patients. There were no significant differences in the amount of albumin received nor acute-on-chronic liver failure grade between those who did and did not develop respiratory failure. The presence of pneumonia independently predicted respiratory failure (odds ratio, 7.80; 95% confidence interval, 2.43-26.95; P < .001). Mortality rate at 28 days was 36%; ATN and hospital-acquired AKI independently predicted 28-day mortality.
CONCLUSIONS: Terlipressin is often used for treatment of AKI outside its primary indication of HRS-AKI. Compared with patients with HRS-AKI, response to terlipressin is significantly lower in patients with ATN, in whom the risks may outweigh the benefits. Respiratory failure is common but does not seem to be driven by the amount of albumin received nor acute-on-chronic liver failure grade.