Amara Vedaghosh, Kulkarni Anand V, Gupta Anand, Venishetty Shantan, Sripathi Shanthi R, Reddy L Siva K, Tirumala Arun Kumar, Karandikar Puja, Alla Manasa, Iyengar Sowmya, Sharma Mithun, Rao Padaki N, Reddy D Nageshwar
Department of Critical Care Medicine, AIG Hospitals, Hyderabad, Telangana, India.
Department of Hepatology and Liver Transplantation, AIG Hospitals, Hyderabad, Telangana, India.
Indian J Crit Care Med. 2024 Nov;28(11):1015-1022. doi: 10.5005/jp-journals-10071-24827. Epub 2024 Oct 30.
A combination of terlipressin and albumin is the standard of care for patients with hepatorenal syndrome-acute kidney injury (HRS-AKI). The study aimed to compare the venous congestion using lung ultrasound score (LUS) and radiographic assessment of lung edema (RALE) scores among terlipressin responders and nonresponders and survivors and non-survivors.
In this single-center, prospective, observational study, we included adult patients with HRS-AKI who had received terlipressin and albumin from 28th April 2022 to 16th October 2022.
Of the 102 patients included, 74.5% (95%CI: 58.7-93.2) responded to terlipressin. The median dose of terlipressin and albumin was 2 (1-8) mg/day and 100 (40-200) g for a duration of 5 (2-10) days. On Kaplan-Meier analysis, survival was 26.9% of patients in the nonresponder group compared to 61.4% in the responder group ( = 0.001). Day 3 LUS score worsened in 76.9% of patients in nonresponders group compared to 52.6% in responder group ( = 0.03). There was a significant increase in RALE score in those who died [6 (-6-48) vs alive: 0 (-4- 30); < 0.001]. Lung ultrasound score had improved or been maintained in 63.6% of patients who were alive, compared to 14.9% in those who had died ( < 0.001). On multivariable Cox regression analysis, age [HR, 1.02 (1.002-1.05)], terlipressin non-response [HR, 2.8 (1.47-5.34)], APACHE score [HR, 1.07 (1.03-1.12)], duration of terlipressin therapy [HR, 0.37 (0.27-0.5)] and worsening of LUS [HR, 2.9 (1.81-7)] predicted mortality.
Lung ultrasound score and chest X-ray can accurately identify venous congestion in the lungs, which is common in patients with advanced liver disease who receive terlipressin and albumin in the intensive care unit (ICU).
Amara V, Kulkarni AV, Gupta A, Venishetty S, Sripathi SR, Reddy LSK, Point-of-care Ultrasonography in Patients with Hepatorenal Syndrome: A Single Center Observational Study. Indian J Crit Care Med 2024;28(11):1015-1022.
