Olayinka Oluwatoba T, Orelus Jaslin, Nisar Mah Rukh, Kotha Rudrani, Saad-Omer Sabaa I, Singh Shivani, Yu Ann Kashmer
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Emergency Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2024 Aug 16;16(8):e67034. doi: 10.7759/cureus.67034. eCollection 2024 Aug.
Hepatorenal syndrome (HRS) is an acute complication of advanced liver disease, which manifests with a rapidly progressive decline in kidney function. Though pharmacological treatment has been recently advanced, there are still high mortality rates. The study compares the mortality rate in patients using different vasoconstrictor agents in the management of HRS. A complete literature search was done in the following databases: PubMed, Cochrane Library, PubMed Central (PMC), and Multidisciplinary Digital Publishing Institute (MDPI). Studies were included according to previously established criteria, in which all studies reporting on adult patients with HRS treated with vasoconstrictor agents were eligible. The data extracted were analyzed with a random-effects model to express variability between studies, and the principal measure was the risk ratio (RR) for mortality. Of the 8,137 studies identified, 29 met the inclusion criteria. In the meta-analysis, vasoconstrictors, mainly terlipressin, significantly improved renal function and decreased the need for renal replacement therapy (RRT) versus placebo. However, a significant impact on mortality was lacking (0.94 (0.84-1.06), p = 0.31). The subgroup analysis found that mortality rates were not significantly different between vasoconstrictors, whether used in combination with or without albumin (0.97 (0.77-1.23), p = 0.79, and 0.98 (0.79-1.21), p = 0.86). Global heterogeneity was low, indicating consistent results in the studies. Vasoconstrictors are helpful in managing HRS, with improvement in renal function and reduction in RRT requirements. However, the effect on mortality was small and nonsignificant. Such findings support the use of terlipressin in HRS management; concomitantly, they emphasize the need for personalized treatment strategies and future research to find alternative therapies that may be more effective for improved survival results with fewer side effects.
肝肾综合征（HRS）是晚期肝病的一种急性并发症，表现为肾功能迅速进行性下降。尽管最近药物治疗有所进展，但死亡率仍然很高。该研究比较了在HRS管理中使用不同血管收缩剂的患者的死亡率。在以下数据库中进行了全面的文献检索：PubMed、Cochrane图书馆、PubMed Central（PMC）和多学科数字出版研究所（MDPI）。根据先前制定的标准纳入研究，所有报告使用血管收缩剂治疗成年HRS患者的研究均符合条件。提取的数据采用随机效应模型进行分析，以表达研究之间的变异性，主要衡量指标是死亡率的风险比（RR）。在确定的8137项研究中，29项符合纳入标准。在荟萃分析中，与安慰剂相比，血管收缩剂（主要是特利加压素）显著改善了肾功能，并减少了肾脏替代治疗（RRT）的需求。然而，对死亡率没有显著影响（0.94（0.84 - 1.06），p = 0.31）。亚组分析发现，无论是否联合白蛋白使用血管收缩剂，死亡率之间没有显著差异（0.97（0.77 - 1.23），p = 0.79，和0.98（0.79 - 1.21），p = 0.86）。总体异质性较低，表明研究结果一致。血管收缩剂有助于管理HRS，可改善肾功能并减少RRT需求。然而，对死亡率的影响较小且不显著。这些发现支持在HRS管理中使用特利加压素；同时，它们强调需要个性化的治疗策略以及未来的研究，以找到可能更有效提高生存结果且副作用更少的替代疗法。
