Original articlePancreas, biliary tract, and liverAssociation Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome
Section snippets
Patients
The study includes 4 different cohorts of consecutive patients with HRS treated with terlipressin and albumin. Some patients were included in prospective investigations already published.4, 5, 10, 13 The first cohort includes patients evaluated from February 2007 to January 2016 at the University Hospital of Padova (Italy), the second cohort includes patients evaluated from July 2009 to December 2015 at the Liver Unit, Hospital Clinic of Barcelona (Spain), the third cohort includes patients
Study Population
Two-hundred and ninety-eight patients with cirrhosis and HRS were included in the study. Supplementary Table 1 illustrates the clinical characteristics of the patients. HRS was associated with bacterial infections in 169 patients (68 with SBP). The most common extrarenal organ failure was liver failure (27%), followed by coagulation failure (13%), brain failure (7%), and respiratory failure (2%). A total of 179 patients (60%) had ACLF-1, 91 (31%) ACLF-2, and 28 (9%) ACLF-3. The characteristics
Discussion
Our study, which represents the largest investigation on the pharmacological treatment of HRS, confirms the 2 major findings so far described. The first is that the combination of terlipressin and albumin is effective resolving HRS in approximately 50% of patients. The second is that baseline sCr or early improvement in sCr are accurate predictors of treatment response and patient survival. It has been proposed that once severe HRS develops, ischemic tubular lesions or renal hypoperfusion
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Conflicts of interest These authors disclose the following: Mauro Bernardi: CLS consultant and speaker for Behring GmbH and Baxter Healthcare SA; speaker for PPTA Europe, Grifols SA, Octpharma AG, Gilead Sciences and AbbVie Italia. Alexander Gerbes: Advisor and speaker for CSL Behring GmbH and Grifols SA. Bernhard Scheiner: travel support from Gilead. Pere Ginès: research funding from Ferring Pharmaceuticals, Grifols SA, and Sequana Medical. Advisory Boards for Noorik, Ikaria, Ferring Pharmaceuticals, Promethera and Sequana Medical. Paolo Angeli: Advisory Board for Sequana Medical AG and BioVie Inc. Research funding from Grifols SA. The other Authors have nothing to disclose. The remaining authors disclose no conflicts.
Funding Elsa Solà is a recipient of a grant “Joan Rodés” from Asociación Española para el Estudio del Higado (AEEH) and a grant from Scietat Catalana de Digestologia. Jonel Trebicka is supported by grants from the Deutsche Forschungsgemeinschaft (SFB TRR57), European Union’s Horizon 2020 Research and Innovation Programme (No 668031) and Cellex Foundation. Pere Gines is a recipient of an ICREA Academia Award. The EASL CLIF Consortium is supported by an unrestricted grant from Grifols.