Real-world practice patterns on the use of terlipressin in patients with cirrhosis and acute kidney injury - results from the ICA-GLOBAL AKI study

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-02-01 DOI:10.1016/j.dld.2025.01.016

S. Incicco , A.T. MA , A. Juanola , K. Patidar , A. Barone , A. Kulkarni , J.L. Pérez-Hernández , B. Wentworth , S. Asrani , C. Alessandria , N. Abdelaaty Abdelkader , Y.J. Wong , Q. Xie , N.T. Pyrsopoulos , S.E. Kim , Y. Fouad , A. Torre , E. Cerda Reyes , J. Diaz-Ferrer , R. Maiwall , S. Piano

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Abstract

Background

Terlipressin is indicated for the treatment of HRS-AKI. However, real-world practice patterns on the use of terlipressin in AKI in general as well as outcomes in non HRS-AKI remain largely unknown.

Method

International prospective study including patients hospitalized for decompensated cirrhosis from July 2022 to May 2023. This was a subgroup analysis of patients who received terlipressin for AKI treatment. Primary outcome was absence of AKI resolution (return of serum creatinine to a value within 0.3 mg/dl of the baseline). Secondary outcomes were incidence of respiratory failure, and 28-day mortality.

Results

Among 1,456 patients with cirrhosis and AKI, 243 (17%) received terlipressin for AKI treatment. Terlipressin was predominantly administered in continuous infusion (75%) at a median maximum daily dose of 3 mg [IQR=2-4] and median duration of 5 days [IQR=3-8]. The AKI phenotype was HRS-AKI in 50%, ATN in 17%, hypovolemia-induced in 25%. Complete AKI resolution occurred in 49% of patients. Lack of AKI resolution was highest in ATN (71%), followed by HRS-AKI (49%). On multivariable analysis ATN was independently associated with lack of AKI resolution (OR 2.77; p=0.016) compared to HRS-AKI, along with AKI stage 3 and ACLF stages 2-3. De novo respiratory failure occurred in 20% of patients treated with terlipressin. No significant differences were found in albumin and terlipressin doses in patients who did and did not developed respiratory failure. Pneumonia (OR=8.29; p<0.001) and lack of volume loss/hypovolemia before AKI (OR=2.70; p=0.029) were independent predictors of respiratory failure. On multivariable analysis, age, ATN, hospital-acquired AKI and MELD score were independent predictors of 28-day mortality.

Conclusion

Terlipressin is often used for treatment of AKI outside its primary indication of HRS-AKI. Since AKI response and clinical outcomes are very poor in ATN, terlipressin should be used with caution in this setting as its risks may outweigh benefits.

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.