Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Indian J Gastroenterol. 2023 Jun;42(3):388-395. doi: 10.1007/s12664-023-01356-6. Epub 2023 May 5.
Terlipressin and noradrenaline are effective in the management of hepatorenal syndrome (HRS). There are no reports on the combination of these vasoconstrictors in type-1 HRS.
To evaluate terlipressin with or without noradrenaline in type-1 HRS not responding to terlipressin at 48 hours.
Sixty patients were randomized to receive either terlipressin (group A; n = 30) or a combination of terlipressin and noradrenaline infusion (group B; n = 30). In group A, terlipressin infusion was started at 2 mg/day and increased by 1 mg/day (maximum 12 mg/day). In group B, terlipressin was given at a constant dose of 2 mg/day. Noradrenaline infusion was started at 0.5 mg/h at baseline and increased to 3 mg/h in a stepwise manner. The primary outcome was treatment response at 15 days. Secondary outcomes were 30-day survival, cost-benefit analysis and adverse events.
There was no significant difference in the response rate between the groups (50% vs. 76.7%, p = 0.06) and 30-day survival was similar (36.7% vs. 53.3%, p = 0.13). Treatment was more expensive in group A (USD 750 vs. 350, p < 0.001). Adverse events were more frequent in group A (36.7% vs. 13.3%, p < 0.05).
The combination of noradrenaline and terlipressin infusion results in a non-significantly higher rate of HRS resolution with significantly fewer adverse effects in HRS patients who do not respond to terlipressin within 48 hours.
gov (NCT03822091).
特利加压素和去甲肾上腺素可有效治疗肝肾综合征（HRS）。目前尚无关于这两种血管收缩剂联合用于 1 型 HRS 的报道。
评估特利加压素联合或不联合去甲肾上腺素治疗对特利加压素治疗 48 小时无反应的 1 型 HRS。
将 60 例患者随机分为两组：特利加压素组（A 组，n=30）或特利加压素联合去甲肾上腺素输注组（B 组，n=30）。A 组以 2mg/天的起始剂量静脉输注特利加压素，剂量逐日增加 1mg（最大剂量 12mg/天）。B 组以 2mg/天的固定剂量静脉输注特利加压素。去甲肾上腺素在基础值时以 0.5mg/h 的起始剂量输注，然后以逐步增加的方式增加至 3mg/h。主要终点为治疗 15 天后的反应。次要终点为 30 天生存率、成本效益分析和不良反应。
两组的应答率无显著差异（50% vs. 76.7%，p=0.06），30 天生存率也相似（36.7% vs. 53.3%，p=0.13）。A 组的治疗费用更高（750 美元 vs. 350 美元，p<0.001）。A 组的不良反应发生率更高（36.7% vs. 13.3%，p<0.05）。
在特利加压素治疗 48 小时内无反应的 HRS 患者中，联合应用去甲肾上腺素和特利加压素输注可显著提高 HRS 缓解率，且不良反应发生率显著降低。
gov（NCT03822091）。
