Real-world Use of Terlipressin in Cirrhosis and Acute Kidney Injury: Frequent Use Beyond Hepatorenal Syndrome.

IF 12 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology Pub Date : 2025-09-08 DOI:10.1016/j.cgh.2025.08.031

Ann T Ma, Adrià Juanola, Kavish R Patidar, Anna Barone, Simone Incicco, Anand V Kulkarni, Nipun Verma, Christian M Lange, Qing Xie, Carlo Alessandria, Eira Cerda Reyes, Rakhi Maiwall, Jeong Han Kim, Sebastián Marciano, Alberto Queiroz Farias, Claudio Toledo, Silvia Nardelli, Julio D Vorobioff, Juan Pablo Roblero, Thierry Thévenot, Maria Papp, Raoel Maan, Cristina Solé, Jacqueline Cordova-Gallardo, Douglas A Simonetto, Yasser Fouad, Lorenz Balcar, Sarah Raevens, Puria Nabilou, Paolo Caraceni, Manuela Merli, José Presa, Wim Laleman, Aleksander Krag, Tony Bruns, Gustavo Pereira, Angelo Z Mattos, Juan Pablo Arab, Brian Wentworth, Nadia Abdelaaty Abdelkader, Yu Jun Wong, Sung-Eun Kim, Olivier Roux, R Bart Takkenberg, Antonio Galante, Luciana Lofego Goncalves, Nikolaos T Pyrsopoulos, José Luis Pérez Hernández, Sumeet K Asrani, Aldo Torre, Javier Díaz-Ferrer, Eric S Orman, Giovanni Perricone, Adrian Gadano, Vladimir Ivashkin, Eduardo Fassio, Mónica Marino, Victor Vargas, Liane Rabinowich, Pedro Montes, Abdulsemed Mohammed, Enrique Carrera, María Cecilia Cabrera, Marcos Girala, Hrishikesh Samant, Joao Madaleno, W Ray Kim, Carlos Noronha Ferreira, Andrew S Allegretti, Shiv K Sarin, Pere Ginès, Paolo Angeli, Elsa Solà, Salvatore Piano

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引用次数: 0

Abstract

Background & aims: Terlipressin is indicated to treat hepatorenal syndrome (HRS)-acute kidney injury (AKI) but is likely used outside this primary indication in clinical practice. We aimed to investigate real-world practice patterns on the use of terlipressin in AKI in cirrhosis.

Methods: International prospective study including patients hospitalized for decompensated cirrhosis. This was a subgroup analysis of patients who received terlipressin to treat AKI. Primary outcome was AKI resolution. Secondary outcomes were respiratory failure and 28-day mortality.

Results: Among 1456 patients with AKI, 243 (17%) received terlipressin. Terlipressin was predominantly administered as a continuous infusion (75%). The AKI phenotype was HRS-AKI in 50%, acute tubular necrosis (ATN) in 17%, hypovolemic in 25%, and other in 8%. AKI resolution occurred in 49% of the patients, and was lowest in ATN (29%), followed by HRS-AKI (51%) and hypovolemic (63%). ATN was independently associated with lack of AKI resolution (odds ratio, 2.77; 95% confidence interval, 1.24-6.54; P = .02). De novo respiratory failure occurred in 20% of patients. There were no significant differences in the amount of albumin received nor acute-on-chronic liver failure grade between those who did and did not develop respiratory failure. The presence of pneumonia independently predicted respiratory failure (odds ratio, 7.80; 95% confidence interval, 2.43-26.95; P < .001). Mortality rate at 28 days was 36%; ATN and hospital-acquired AKI independently predicted 28-day mortality.

Conclusions: Terlipressin is often used for treatment of AKI outside its primary indication of HRS-AKI. Compared with patients with HRS-AKI, response to terlipressin is significantly lower in patients with ATN, in whom the risks may outweigh the benefits. Respiratory failure is common but does not seem to be driven by the amount of albumin received nor acute-on-chronic liver failure grade.

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特利加压素在肝硬化和急性肾损伤中的实际应用：除肝肾综合征外的频繁使用。

背景与目的：特立加压素是治疗肝肾综合征(HRS)-急性肾损伤（AKI）的适应症，但在临床实践中可能在这一主要适应症之外使用。我们的目的是调查在肝硬化AKI患者中使用特利加压素的现实实践模式。方法：纳入失代偿期肝硬化住院患者的国际前瞻性研究。这是接受特利加压素治疗AKI患者的亚组分析。主要结局是AKI的缓解。次要结局是呼吸衰竭和28天死亡率。结果：1456例AKI患者中，243例（17%）接受特利加压素治疗。特立加压素以连续输注为主（75%）。急性肾小管坏死（ATN）占17%，低血容量性占25%，其他占8%。49%的患者出现AKI缓解，ATN患者最低（29%），其次是rs -AKI（51%）和低血容量（63%）。ATN与AKI分辨率缺乏独立相关（OR=2.77, 95%CI=1.24-6.54, p=0.02）。20%的患者发生新生呼吸衰竭。在接受白蛋白治疗的数量和急性慢性肝衰竭（ACLF）分级方面，有呼吸衰竭和没有呼吸衰竭的患者没有显著差异。肺炎的存在独立预测呼吸衰竭（OR=7.80, 95%CI=2.43-26.95）。结论：特利加压素常用于治疗肾综合征肾损伤（AKI）的主要适应症之外。与rs - aki患者相比，ATN患者对特利加压素的反应明显较低，其风险可能大于益处。呼吸衰竭是常见的，但似乎不是由接受白蛋白的量或ACLF分级驱动的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

16.90

自引率

4.80%

发文量

903

审稿时长

22 days

期刊介绍： Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.