Salvatore Piano1, Hartmut H Schmidt2, Xavier Ariza3, Alex Amoros4, Antonietta Romano1, Anna Hüsing-Kabar2, Elsa Solà3, Alexander Gerbes5, Mauro Bernardi6, Carlo Alessandria7, Bernhard Scheiner8, Marta Tonon1, Miriam Maschmeier2, Cristina Solè3, Jonel Trebicka9, Thierry Gustot10, Frederik Nevens11, Vicente Arroyo4, Pere Gines12, Paolo Angeli13. 1. Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED University of Padova, Padova, Italy. 2. Klinik für Transplantationsmedizin, Universitätsklinikum Münster, Münster, Germany. 3. Liver Unit, Hospital Clìnic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; 5 - Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain. 4. EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain. 5. Department of Medicine II, University Hospital LMU Munich, Liver Center Munich, Munich, Germany. 6. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 7. Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Torino, Italy. 8. Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. 9. EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain; Department of Internal Medicine I, University of Bonn, Bonn, Germany; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Institute for Bioengineering of Catalonia, Barcelona, Spain. 10. Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. 11. University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium. 12. Liver Unit, Hospital Clìnic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; 5 - Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain; EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain. 13. Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED University of Padova, Padova, Italy. Electronic address: pangeli@unipd.it.
Abstract
BACKGROUND & AIMS: Type 1 hepatorenal syndrome (HRS) is the most high-risk type of renal failure in patients with cirrhosis. Terlipressin and albumin are effective treatments for type 1 HRS. However, the effects of acute on chronic liver failure (ACLF) grade on response to treatment are not clear. We aimed to identify factors associated with response to treatment with terlipressin and albumin in patients with type 1 HRS (reduction in serum level of creatinine to below 1.5 mg/dL at the end of treatment) and factors associated with death within 90 days of HRS diagnosis (90-day mortality). METHODS: We performed a retrospective analysis of 4 different cohorts of consecutive patients with HRS treated with terlipressin and albumin from February 2007 through January 2016 at medical centers in Europe (total, 298 patients). We analyzed demographic, clinical, and laboratory data collected before and during treatment; patients were followed until death, liver transplantation, or 90 days after HRS diagnosis. RESULTS: Response to treatment was observed in 53% of patients. Of patients with grade 1 ACLF, 60% responded to treatment; among those with grade 2 ACLF, 48% responded, and among those with grade 3 ACLF, 29% responded (P < .001 for comparison between grades). In multivariate analysis, baseline serum level of creatinine (odds ratio, 0.23; P = .001) and ACLF grade (odds ratio, 0.63; P = .01) were independently associated with response to treatment. Patient age (hazard ratio [HR], 1.05; P < .001), white blood cell count (HR, 1.51; P = .006), ACLF grade (HR, 2.06; P < .001), and no response to treatment (HR, 0.41; P < .001) associated with 90-day mortality. CONCLUSION: In a retrospective analysis of data from 4 cohorts of patients treated for type 1 HRS, we found ACLF grade to be the largest determinant of response to terlipressin and albumin. ACLF grade affects survival independently of response to treatment. New therapeutic strategies should be developed for patients with type 1 HRS and extrarenal organ failure.
BACKGROUND & AIMS:Type 1 hepatorenal syndrome (HRS) is the most high-risk type of renal failure in patients with cirrhosis. Terlipressin and albumin are effective treatments for type 1 HRS. However, the effects of acute on chronic liver failure (ACLF) grade on response to treatment are not clear. We aimed to identify factors associated with response to treatment with terlipressin and albumin in patients with type 1 HRS (reduction in serum level of creatinine to below 1.5 mg/dL at the end of treatment) and factors associated with death within 90 days of HRS diagnosis (90-day mortality). METHODS: We performed a retrospective analysis of 4 different cohorts of consecutive patients with HRS treated with terlipressin and albumin from February 2007 through January 2016 at medical centers in Europe (total, 298 patients). We analyzed demographic, clinical, and laboratory data collected before and during treatment; patients were followed until death, liver transplantation, or 90 days after HRS diagnosis. RESULTS: Response to treatment was observed in 53% of patients. Of patients with grade 1 ACLF, 60% responded to treatment; among those with grade 2 ACLF, 48% responded, and among those with grade 3 ACLF, 29% responded (P < .001 for comparison between grades). In multivariate analysis, baseline serum level of creatinine (odds ratio, 0.23; P = .001) and ACLF grade (odds ratio, 0.63; P = .01) were independently associated with response to treatment. Patient age (hazard ratio [HR], 1.05; P < .001), white blood cell count (HR, 1.51; P = .006), ACLF grade (HR, 2.06; P < .001), and no response to treatment (HR, 0.41; P < .001) associated with 90-day mortality. CONCLUSION: In a retrospective analysis of data from 4 cohorts of patients treated for type 1 HRS, we found ACLF grade to be the largest determinant of response to terlipressin and albumin. ACLF grade affects survival independently of response to treatment. New therapeutic strategies should be developed for patients with type 1 HRS and extrarenal organ failure.
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Authors: Andrew S Allegretti; Xavier Vela Parada; Paul Endres; Sophia Zhao; Scott Krinsky; Shelsea A St Hillien; Sahir Kalim; Sagar U Nigwekar; James G Flood; Andrea Nixon; Douglas A Simonetto; Luis A Juncos; Nithin Karakala; Hani M Wadei; Kevin R Regner; Justin M Belcher; Mitra K Nadim; Guadalupe Garcia-Tsao; Juan Carlos Q Velez; Samir M Parikh; Raymond T Chung Journal: Clin Transl Gastroenterol Date: 2021-05-11 Impact factor: 4.396