Liver Transplantation and Hepatobiliary Medicine, Royal Free Hospital, London, UK.
Eur J Gastroenterol Hepatol. 2010 Apr;22(4):481-6. doi: 10.1097/MEG.0b013e3283345524.
Renal failure is common in cirrhosis frequently due to hepatorenal syndrome (HRS). Terlipressin and albumin improve renal function with a trend to prolong survival in HRS, but prognostic factors with therapy have been poorly studied.
Forty-five cirrhotics seen consecutively in a single centre with renal failure defined as oliguria/anuria and/or rising creatinine and no response to volume loading, without intrinsic renal disease, sepsis, gastrointestinal bleeding [median Child-Pugh score 12(8-14)/Model for End-Stage Liver Disease 29(10-40)], had intravenous terlipressin and albumin and were audited retrospectively classified into three groups: group 1 HRS type 1 (15), group 2 HRS type 2 (11) and group 3(19): not fulfilling HRS 1 or 2 criteria. Baseline median creatinine was 1.7 (0.9-5.46) mg/dl and 30 (67%) had creatinine greater than 1.5 mg/dl. All 45 patients had initial colloid/albumin and 31 continued terlipressin (2-4 mg/day) for a median 8 (2-76) days.
Improvement in serum creatinine occurred in 23 (51%) [(1.3 mg/dl (0.6-3.9)] compared with baseline [1.7 mg/dl (0.92-3.75)] (P<0.001). In the multivariate analysis a greater reduction in creatinine between baseline and day 4 (95% confidence interval, odds ratio: 0.25) was associated with improved survival at 6 weeks.
Albumin and terlipressin improve renal failure in the absence of sepsis in cirrhosis independently of whether HRS criteria are fulfilled or not. Improvement at 4 days of therapy is associated with better survival. Randomized studies are needed for oliguria and rising creatinine in cirrhotics even if HRS criteria are not fulfilled.
肝硬化患者常因肝肾综合征（HRS）而出现肾功能衰竭。特利加压素和白蛋白可改善肾功能，并可延长 HRS 患者的生存时间，但与治疗相关的预后因素尚未得到充分研究。
在一个单一中心，对 45 例连续就诊的肝硬化伴肾衰竭患者进行回顾性分析，肾衰竭定义为少尿/无尿和/或肌酐升高且对容量负荷无反应，无内在肾脏疾病、脓毒症、胃肠道出血[中位 Child-Pugh 评分 12（8-14）/终末期肝病模型评分 29（10-40）]。所有患者均接受特利加压素和白蛋白静脉治疗，并根据是否符合 HRS1 或 2 型标准分为三组：1 组 HRS 1 型（15 例），2 组 HRS 2 型（11 例）和 3 组（19 例）：不符合 HRS1 或 2 型标准。基线中位数肌酐为 1.7（0.9-5.46）mg/dl，30 例（67%）肌酐>1.5mg/dl。所有 45 例患者均接受初始胶体/白蛋白治疗，31 例患者继续接受特利加压素（2-4mg/天）治疗，中位数时间为 8（2-76）天。
与基线相比，23 例（51%）患者的血清肌酐改善[1.3mg/dl（0.6-3.9）]（P<0.001）。多变量分析显示，在第 4 天与基线相比肌酐降低幅度更大（95%置信区间，比值比：0.25）与 6 周时的生存改善相关。
白蛋白和特利加压素可改善肝硬化患者的肾衰竭，而与是否存在 HRS 标准无关。治疗第 4 天的改善与更好的生存相关。即使不符合 HRS 标准，对于肝硬化伴少尿和肌酐升高的患者也需要进行随机研究。
