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Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome.
Clin Gastroenterol Hepatol 2018; 16(11):1792-1800.e3CG

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.

Authors+Show Affiliations

Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED University of Padova, Padova, Italy.Klinik für Transplantationsmedizin, Universitätsklinikum Münster, Münster, Germany.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.Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED University of Padova, Padova, Italy.Klinik für Transplantationsmedizin, Universitätsklinikum Münster, Münster, Germany.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.Department of Medicine II, University Hospital LMU Munich, Liver Center Munich, Munich, Germany.Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, Torino, Italy.Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED University of Padova, Padova, Italy.Klinik für Transplantationsmedizin, Universitätsklinikum Münster, Münster, Germany.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; 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.Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.EASL CLIF Consortium, European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain.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.Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED University of Padova, Padova, Italy. Electronic address: pangeli@unipd.it.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29391267

Citation

Piano, Salvatore, et al. "Association Between Grade of Acute On Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 16, no. 11, 2018, pp. 1792-1800.e3.
Piano S, Schmidt HH, Ariza X, et al. Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome. Clin Gastroenterol Hepatol. 2018;16(11):1792-1800.e3.
Piano, S., Schmidt, H. H., Ariza, X., Amoros, A., Romano, A., Hüsing-Kabar, A., ... Angeli, P. (2018). Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 16(11), pp. 1792-1800.e3. doi:10.1016/j.cgh.2018.01.035.
Piano S, et al. Association Between Grade of Acute On Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome. Clin Gastroenterol Hepatol. 2018;16(11):1792-1800.e3. PubMed PMID: 29391267.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Grade of Acute on Chronic Liver Failure and Response to Terlipressin and Albumin in Patients With Hepatorenal Syndrome. AU - Piano,Salvatore, AU - Schmidt,Hartmut H, AU - Ariza,Xavier, AU - Amoros,Alex, AU - Romano,Antonietta, AU - Hüsing-Kabar,Anna, AU - Solà,Elsa, AU - Gerbes,Alexander, AU - Bernardi,Mauro, AU - Alessandria,Carlo, AU - Scheiner,Bernhard, AU - Tonon,Marta, AU - Maschmeier,Miriam, AU - Solè,Cristina, AU - Trebicka,Jonel, AU - Gustot,Thierry, AU - Nevens,Frederik, AU - Arroyo,Vicente, AU - Gines,Pere, AU - Angeli,Paolo, AU - ,, Y1 - 2018/01/31/ PY - 2017/12/06/received PY - 2018/01/12/revised PY - 2018/01/21/accepted PY - 2018/2/3/pubmed PY - 2019/11/16/medline PY - 2018/2/3/entrez KW - Acute kidney Injury KW - Cirrhosis KW - Hepatorenal Syndrome KW - Liver Transplantation SP - 1792 EP - 1800.e3 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 16 IS - 11 N2 - 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. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/29391267/Association_Between_Grade_of_Acute_on_Chronic_Liver_Failure_and_Response_to_Terlipressin_and_Albumin_in_Patients_With_Hepatorenal_Syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(18)30105-8 DB - PRIME DP - Unbound Medicine ER -