Poor outcomes with treatment of hepatorenal syndrome type 1 with splanchnic vasoconstrictors and albumin: report of seven cases and review of the literature.
| Autor: | Kalil JR; Unit of Gastroenterology and Hepatology, Hospital Português, Salvador, BA, Brazil., Cerqueira LA, Barbosa DS, Motta MP, Nery Mda S, Bittencourt PL |
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| Jazyk: | angličtina |
| Zdroj: | Arquivos de gastroenterologia [Arq Gastroenterol] 2009 Jul-Sep; Vol. 46 (3), pp. 214-8. |
| DOI: | 10.1590/s0004-28032009000300014 |
| Abstrakt: | Context: Treatment of hepatorenal syndrome type 1 (HRS-1) with splanchnic vasoconstrictors and high-dose albumin has been associated with reversal of renal failure in approximately 60% to 80% of the cases in pilot or uncontrolled studies. Objective: To evaluate the results of treatment of HRS-1 with terlipressin and high-dose albumin. Methods: All patients with HRS-1 that underwent treatment with terlipressin and high-dose albumin at our unit were retrospectively reviewed. Outcomes including reversal of renal failure and death were recorded and compared to baseline clinical and laboratory parameters. Results: Seven subjects (median age 64 [47-69] years, 5 males) with median Child-Pugh and MELD scores of 12 [10-15] and 22 [17-38], respectively, hospitalized with decompensated chronic liver disease secondary to tense ascitis and infections, who exhibited criteria for HRS-1, were submitted to therapy with terlipressin and high-dose albumin according to a predefined standard protocol. Baseline creatinine levels were 2.9 [2.3-4.0] mg/mL. None of the patients achieved reversal of HRS-1 and five subjects died on-treatment due to sudden-death (n = 1), multiple organ dysfunction associated with end-stage liver failure (n = 2) and sepsis (n = 2). Conclusions: Treatment of HRS-1 with terlipressin and high-dose albumin was not associated with reversal of renal failure, but most of the treated subjects had severe end-stage liver disease with high MELD scores as well as high baseline creatinine values, parameters previously associated with bad outcomes. |
| Databáze: | MEDLINE |
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