Xu Xiangbo, Liu Bang, Lin Su, Li Bimin, Wu Yunhai, Li Yiling, Zhu Qiang, Yang Yida, Tang Shanhong, Meng Fanping, Chen Yu, Yuan Shanshan, Shao Lichun, Bernardi Mauro, Yoshida Eric M, Qi Xingshun
Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly Called General Hospital of Shenyang Military Area), Shenyang, China.
Department of Hepatobiliary Disease, Fuzong Clinical Medical College of Fujian Medical University & 900 Hospital of the Joint Logistics Team, Fuzhou, China.
Adv Ther. 2020 Oct;37(10):4396-4413. doi: 10.1007/s12325-020-01466-z. Epub 2020 Aug 28.
Acute gastrointestinal bleeding (GIB) rapidly reduces effective blood volume, thereby precipitating acute kidney injury (AKI). Terlipressin, which can induce splanchnic vasoconstriction and increase renal perfusion, has been recommended for acute GIB and hepatorenal syndrome in liver cirrhosis. Thus, we hypothesized that terlipressin might be beneficial for cirrhotic patients with acute GIB and renal impairment.
In this Chinese multi-center study, 1644 cirrhotic patients with acute GIB were retrospectively enrolled. AKI was defined according to the International Club of Ascites (ICA) criteria. Renal dysfunction was defined as serum creatinine (sCr) > 133 μmol/L at admission and/or any time point during hospitalization. Incidence of renal impairment and in-hospital mortality were the primary end-points.
The incidence of any stage ICA-AKI, ICA-AKI stages 1B, 2, and 3, and renal dysfunction in cirrhotic patients with acute GIB was 7.1%, 1.8%, and 5.0%, respectively. The in-hospital mortality was significantly increased by renal dysfunction (14.5% vs. 2.2%, P < 0.001) and ICA-AKI stages 1B, 2, and 3 (11.1% vs. 2.8%, P = 0.011), but not any stage ICA-AKI (5.7% vs. 2.7%, P = 0.083). The in-hospital mortality was significantly decreased by terlipressin in patients with renal dysfunction (3.6% vs. 20.0%, P = 0.044), but not in those with any stage ICA-AKI (4.5% vs. 6.0%, P = 0.799) or ICA-AKI stages 1B, 2, and 3 (0.0% vs. 14.3%, P = 0.326).
Renal dysfunction increased the in-hospital mortality of cirrhotic patients with acute GIB. Terlipressin might decrease the in-hospital mortality of cirrhotic patients with acute GIB and renal dysfunction.
NCT03846180 ( https://clinicaltrials.gov ).
急性胃肠道出血（GIB）会迅速减少有效血容量，从而引发急性肾损伤（AKI）。特利加压素可诱导内脏血管收缩并增加肾灌注，已被推荐用于治疗急性GIB和肝硬化患者的肝肾综合征。因此，我们推测特利加压素可能对肝硬化合并急性GIB及肾功能损害的患者有益。
在这项中国多中心研究中，对1644例肝硬化合并急性GIB的患者进行了回顾性纳入。AKI根据国际腹水俱乐部（ICA）标准定义。肾功能不全定义为入院时和/或住院期间任何时间点血清肌酐（sCr）>133μmol/L。肾功能损害发生率和院内死亡率为主要终点。
肝硬化合并急性GIB患者中，任何阶段的ICA-AKI、ICA-AKI 1B、2和3期以及肾功能不全的发生率分别为7.1%、1.8%和5.0%。肾功能不全（14.5%对2.2%，P<0.001）以及ICA-AKI 1B、2和3期（11.1%对2.8%，P=0.011）显著增加了院内死亡率，但任何阶段的ICA-AKI（5.7%对2.7%，P=0.083）未增加。特利加压素使肾功能不全患者的院内死亡率显著降低（3.6%对20.0%，P=0.044），但对任何阶段ICA-AKI患者（4.5%对6.0%，P=0.799）或ICA-AKI 1B、2和3期患者（0.0%对14.3%，P=0.326）无此作用。
肾功能不全会增加肝硬化合并急性GIB患者的院内死亡率。特利加压素可能会降低肝硬化合并急性GIB及肾功能不全患者的院内死亡率。
NCT03846180（https://clinicaltrials.gov）
