Division of Gastroenterology, Mountain Vista Medical Center, Mesa, AZ, United States.
Airedale General Hospital, West Yorkshire, United Kingdom.
Ann Hepatol. 2024 Jul-Aug;29(4):101495. doi: 10.1016/j.aohep.2024.101495. Epub 2024 Mar 7.
Hepatorenal syndrome (HRS) is a serious complication of cirrhosis treated with various medications. We aim to evaluate terlipressin and albumin's effectiveness and safety compared to albumin and noradrenaline in adult hepatorenal disease patients.
Clinical trials from four databases were included. Cochrane's approach for calculating bias risk was utilized. We rated the quality evaluation by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We included the following outcomes: serum creatinine (mg/dl), urine output (ml/24 h), mean arterial pressure (mmHg), reversal rate of HRS, mortality rate, blood plasma renin activity (ng/ml/h), plasma aldosterone concentration (pg/ml), urine sodium (mEq/l), and creatinine clearance (ml/min).
Our analysis of nine clinical studies revealed that the noradrenaline group was associated with higher creatinine clearance (MD = 4.22 [0.40, 8.05]), (P = 0.03). There were no significant differences in serum creatinine levels (MD = 0.03 [-0.07, 0.13]), urinary sodium (MD = -1.02 [-5.15, 3.11]), urine output (MD = 32.75 [-93.94, 159.44]), mean arterial pressure (MD = 1.40 [-1.17, 3.96]), plasma renin activity (MD = 1.35 [-0.17, 2.87]), plasma aldosterone concentration (MD = 55.35 [-24.59, 135.29]), reversal rate of HRS (RR = 1.15 [0.96, 1.37]), or mortality rate (RR = 0.87 [0.74, 1.01]) between the two groups (p-values > 0.05).
Noradrenaline is a safe alternative medical therapy for HRS.
肝肾综合征（HRS）是肝硬化患者接受各种药物治疗的严重并发症。我们旨在评估特利加压素和白蛋白与白蛋白和去甲肾上腺素相比，在成人肝肾疾病患者中的疗效和安全性。
纳入来自四个数据库的临床试验。我们采用 Cochrane 方法计算偏倚风险。我们通过 Grading of Recommendations Assessment, Development, and Evaluation（GRADE）进行质量评估评级。我们纳入了以下结局：血清肌酐（mg/dl）、尿量（ml/24 h）、平均动脉压（mmHg）、HRS 逆转率、死亡率、血浆肾素活性（ng/ml/h）、血浆醛固酮浓度（pg/ml）、尿钠（mEq/l）和肌酐清除率（ml/min）。
我们对 9 项临床研究的分析显示，去甲肾上腺素组的肌酐清除率更高（MD = 4.22 [0.40, 8.05]，P = 0.03）。两组间血清肌酐水平（MD = 0.03 [-0.07, 0.13]）、尿钠（MD = -1.02 [-5.15, 3.11]）、尿量（MD = 32.75 [-93.94, 159.44]）、平均动脉压（MD = 1.40 [-1.17, 3.96]）、血浆肾素活性（MD = 1.35 [-0.17, 2.87]）、血浆醛固酮浓度（MD = 55.35 [-24.59, 135.29]）、HRS 逆转率（RR = 1.15 [0.96, 1.37]）和死亡率（RR = 0.87 [0.74, 1.01]）均无显著差异（p 值均＞0.05）。
去甲肾上腺素是 HRS 的一种安全替代治疗药物。
