First Department of Medicine, Cirrhosis Center Mainz (CCM), University Hospital Mainz, Mainz, Germany.
Department of Medicine II, Klinikum Osnabrück, Osnabrück, Germany.
United European Gastroenterol J. 2019 May;7(4):529-537. doi: 10.1177/2050640619825719. Epub 2019 Feb 20.
Hepatorenal syndrome (HRS) is associated with a poor prognosis. In HRS type 1, loss of renal function is rapidly progressive, while HRS type 2 is characterised by chronic ascites and more moderately elevated renal parameters. While treatment with terlipressin/albumin is well established in type 1, its effectiveness in chronic HRS is less clear.
The aim of this study was to evaluate the effectiveness of terlipressin/albumin treatment in patients with HRS type 2.
All patients with a first episode of HRS between April 2013 and February 2016 were included in this observational study. Relevant clinical and laboratory parameters were recorded and patients were followed.
A total of 106 patients with HRS were included. With terlipressin therapy reversal of HRS types 1 and 2 was achieved in 48% and 46% of patients ( = 0.84) with relapse rates of 8% vs 50% ( = 0.001). Overall survival (OS) and survival free of liver transplantation (LTx) were similar in HRS types 1 and 2 ( = 0.69; = 0.64). In multivariate analysis response to treatment was independently associated with better OS in HRS type 2, in addition to established risk factors such as lower Model for End-Stage Liver Disease score, absence of hepatic encephalopathy and eligibility for LTx.
A terlipressin treatment course seems to be justified in selected patients with HRS type 2, especially in countries and settings with long transplant waiting lists. In addition treatment response might also help to identify HRS type 2 patients with a more favourable outcome.
肝肾综合征（HRS）与预后不良相关。在 HRS 1 型中，肾功能丧失呈进行性发展，而 HRS 2 型的特征是慢性腹水和肾脏参数中度升高。特利加压素/白蛋白治疗在 1 型中已得到充分证实，但其在慢性 HRS 中的疗效尚不清楚。
本研究旨在评估特利加压素/白蛋白治疗 HRS 2 型的疗效。
本观察性研究纳入了 2013 年 4 月至 2016 年 2 月期间首次发生 HRS 的所有患者。记录了相关的临床和实验室参数，并对患者进行了随访。
共纳入 106 例 HRS 患者。特利加压素治疗使 HRS 1 型和 2 型逆转的患者比例分别为 48%和 46%（ = 0.84），复发率分别为 8%和 50%（ = 0.001）。HRS 1 型和 2 型的总生存率（OS）和无肝移植（LTx）生存率相似（ = 0.69； = 0.64）。多因素分析显示，治疗反应与 HRS 2 型患者的 OS 改善独立相关，除了终末期肝病模型评分较低、无肝性脑病和符合 LTx 条件等已确立的风险因素外。
特利加压素治疗疗程在某些 HRS 2 型患者中似乎是合理的，尤其是在移植等待时间较长的国家和地区。此外，治疗反应也可能有助于识别预后较好的 HRS 2 型患者。
