Hiruy Aklil, Nelson Joelle, Zori Andreas, Morelli Giuseppe, Cabrera Roniel, Kamel Amir
Department of Pharmacy, University of Florida Health Shands, Gainesville.
Department of Pharmacy, University Health System, San Antonio.
Eur J Gastroenterol Hepatol. 2021 Jan;33(1):102-106. doi: 10.1097/MEG.0000000000001700.
Hepatorenal syndrome (HRS) remains a serious complication of cirrhosis with a high mortality rate. There is little information on the effect of standardizing albumin, midodrine and octreotide combination on treatment response in patients with HRS.
The aim of the study was to determine the impact of a standardized HRS treatment regimen on renal function recovery. The primary outcome was full response rate. Secondary outcomes included partial and no response rates, 30-day all-cause mortality, ICU length of stay (LOS), hospital LOS, liver transplantation and total dose of albumin.
This retrospective study evaluated the impact of using a standardized approach with albumin, midodrine and octreotide on treatment response rates compared to a historical group.
Of the patients with HRS, 28 received a standardized approach with albumin, midodrine and octreotide while 60 received a nonstandardized approach. Ten percent of patients achieved full response in the prestandardization group compared with 25% in the poststandardization group (P = 0.07). Renal replacement therapy was significantly more prevalent in the prestandardization group vs. poststandardization group (45% vs. 21.4%, P = 0.03). Liver transplantation was performed significantly more often in the prestandardization group compared the poststandardization group (23% vs. 3.6%, P = 0.02). Amount of albumin used was statistically lower in the poststandardization group (425 vs. 332 g, P = 0.05). No significant differences in days of HRS treatment, mortality rate, hospital and ICU LOS were observed.
A trend towards improved treatment response rate was observed after standardizing the HRS treatment regimen. Standardized therapy led to significantly lower rates of renal replacement therapy and liver transplantation, suggesting patients in poststandardization were effectively managed medically without requiring further intervention.
肝肾综合征（HRS）仍然是肝硬化的一种严重并发症，死亡率很高。关于标准化白蛋白、米多君和奥曲肽联合使用对HRS患者治疗反应的影响，相关信息较少。
本研究旨在确定标准化HRS治疗方案对肾功能恢复的影响。主要结局是完全缓解率。次要结局包括部分缓解率和无缓解率、30天全因死亡率、重症监护病房（ICU）住院时间、医院住院时间、肝移植情况以及白蛋白总剂量。
这项回顾性研究评估了与历史对照组相比，采用标准化白蛋白、米多君和奥曲肽治疗方法对治疗反应率的影响。
在HRS患者中，28例接受了白蛋白、米多君和奥曲肽的标准化治疗方法，而60例接受了非标准化治疗方法。标准化治疗前组患者的完全缓解率为10%，而标准化治疗后组为25%（P = 0.07）。与标准化治疗后组相比，标准化治疗前组接受肾脏替代治疗的比例显著更高（45%对21.4%，P = 0.03）。与标准化治疗后组相比，标准化治疗前组进行肝移植的比例显著更高（23%对3.6%，P = 0.02）。标准化治疗后组使用的白蛋白量在统计学上更低（425克对332克，P = 0.05）。在HRS治疗天数、死亡率、医院和ICU住院时间方面未观察到显著差异。
在标准化HRS治疗方案后，观察到治疗反应率有改善的趋势。标准化治疗导致肾脏替代治疗和肝移植率显著降低，这表明标准化治疗后组的患者通过药物治疗得到了有效管理，无需进一步干预。
