Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics.
Predictors of response to terlipressin plus albumin in hepatorenal syndrome (HRS) type 1: relationship of serum creatinine to hemodynamics.
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DOI：
10.1016/j.jhep.2010.11.020
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发表时间：
2011-08
影响因子：
25.7
通讯作者：
Teuber, Peter
中科院分区：
文献类型：
--
作者：
Boyer, Thomas D.;Sanyal, Arun J.;Garcia-Tsao, Guadalupe;Blei, Andres;Carl, Daniel;Bexon, Alice S.;Teuber, Peter
与单独使用白蛋白相比，特利加压素联合白蛋白给药可有效逆转1型HRS。然而，只有约1/3的患者对治疗有反应，因此，反应和生存的预测因子将有助于确定最有可能从治疗中获益的患者。我们分析了特利加压素与安慰剂的对照试验（Gastroenterology 2008;134：1360），以确定预测反应的因素，并将血流动力学变化与肾功能变化相关联。单变量分析显示特利加压素治疗、MELD评分和基线血清肌酐可预测HRS逆转。酒精性肝炎、基线血清肌酐和MELD评分可预测生存率。当治疗不被认为是一个变量时，只有基线血清肌酐预测HRS逆转。多变量分析显示，基线血清肌酐、酒精性肝炎和Child-Pugh评分也可预测生存率。特利加压素给药后平均动脉压（MAP）升高不能预测HRS逆转。然而，在特利加压素实现HRS逆转的患者中，从治疗开始到结束MAP显著升高。对特利加压素的反应和生存的最一致的预测因子是基线血清肌酐。最有可能受益于特利加压素的患者具有较早发作的肾衰竭（即血清肌酐<5.0 mg/dl）。HR逆转需要MAP持续升高。由于MAP是高动力循环的替代标志物，因此只有在高动力循环改善的情况下才能观察到HRS逆转。
Administration of terlipressin plus albumin is effective in reversing type 1 HRS as compared to albumin alone. However, only about 1/3 of patients respond to treatment, therefore, predictors of response and survival would help identify the patients most likely to benefit from treatment. We analyzed our controlled trial of terlipressin vs. placebo (Gastroenterology 2008;134:1360) to define factors predictive of a response and to correlate hemodynamic changes to changes in renal function. Single variant analysis showed treatment with terlipressin, MELD score, and baseline serum creatinine to be predictive of HRS reversal. Alcoholic hepatitis, baseline serum creatinine, and MELD score were predictive of survival. When treatment was not considered as a variable, only baseline serum creatinine predicted HRS reversal. Baseline serum creatinine, presence of alcoholic hepatitis, and Child-Pugh score were also predictive of survival on multivariate analysis. The rise in mean arterial pressure (MAP) following terlipressin administration was not predictive of HRS reversal. However, in those who achieved HRS reversal from terlipressin, there was a significant rise in MAP from beginning to end of treatment. The most consistent predictor of response to terlipressin and of survival is the baseline serum creatinine. Patients most likely to benefit from terlipressin have earlier onset renal failure (i.e. serum creatinine <5.0 mg/dl). A sustained rise in MAP is required for HRS reversal. As MAP is a surrogate marker for the hyperdynamic circulation, it is only with improvement in the hyperdynamic circulation that HRS reversal is observed.
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影响因子：
25.7
作者：
Uriz, J;Ginès, P;Rodés, J
通讯作者：
Rodés, J
影响因子：
29.4
作者：
Sanyal, Arun J.;Boyer, Thomas;Teuber, Peter
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Teuber, Peter
影响因子：
29.4
作者：
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通讯作者：
RODES, J
影响因子：
3.1
作者：
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影响因子：
29.4
作者：
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