Terlipressin in 33 Patients with Hepatorenal Syndrome: Results of a Retrospective Study on Duration and Dose of Terlipressin Therapy

Abstract

Introduction: Terlipressin is known to improve renal function in patients with liver cirrhosis and hepatorenal syndrome (HRS). This study investigated retrospectively effects of duration and dose of terlipressin therapy and predictive factors for positive response to treatment. Methods: HRS was defined as increase in serum creatine value >1.5mg/dL and decrease of glomerular filtration rate to <40 mL/min in patients with cirrhosis and failure of improvement after intensified i.v.-fluid- administration. Diuretics were discontinued and other reasons for renal dysfunction were excluded. Treatment was based on a determined therapeutic scheme. Terlipressin (1mg bolus / 6 hours i.v.) was administered combined with Albumin (1g/kg on day 1, thereon 20g in patients <70kg and 40g in patients >70kg per day). Dose rate of Terlipressin was doubled in the event of failure to treatment after 72 hours. Patients received therapy either until complete response was achieved (defined as serum creatinine value <1.5mg/dL) or until therapy needed to be interrupted due to adverse reactions or vital complications of the underlying disease. Results: The clinical charts of 33 consecutive patients (19 men, 14 women; age range 32–68 years) with HRS (25 with type I HRS, 8 with type II HRS), who received terlipressin from 01/2005 to 12/2006, were retrospectivly studied. Creatinine serum values were in-between 1.7mg/dL and 7.1mg/dL at inclusion. 24 (69%) of the 33 patients showed complete response to treatment (Kaplan-Meier method). In these patients the median duration of therapy was 5 days +/–6.2 (SD). In the nonresponder group it was 6 days +/–31.1. The median dose of terlipressin in the responder group was 4mg per day +/–2.2 and 2mg per day +/–2.5 in the nonresponder group. The probability that complete response was obtained at day 20 of treatment was 83% (95% CI 0.66–0.95), whereas at day 7 it was just 56% (95% CI 0.39–0.74). Prolongation of treatment beyond 20 days showed no measurable effect (see Fig.1). Cox regression analysis showed that Child-Pugh score and level of serum creatinine at time of inclusion were without effect on the outcome (p=0.91, 95% CI 0.43–2.54 and p=0.06, 95% CI 0.46–1.01, respectively). Conclusion: In conclusion, these data show that terlipressin is effective in more than two- thirds of patients with HRS. Prolongation of treatment beyond 7 days up to 20 days is capable of increasing the response rates.