Novel predictors of response to therapy with terlipressin and albumin in hepatorenal syndrome–acute kidney injury

Abstract

Background A combination of terlipressin and albumin is the first-line pharmacologic treatment for hepatorenal syndrome–acute kidney injury (HRS-AKI). We assessed the response rates to terlipressin–albumin therapy in patients with HRS-AKI and determined early predictors of treatment response and survival.

Methods A total of 84 patients with HRS-AKI (International Club of Ascites definition 2015) treated with terlipressin–albumin were included. Predictors of HRS reversal were identified by logistic regression analysis. Survival analysis was performed using the Kaplan-Meier method, and Cox regression models were used to determine independent predictors of mortality.

Results Complete response to therapy was observed in 54.8%, partial response in 14.3%, and no response in 31% of patients. The factors associated with complete treatment response were the presence of systemic inflammatory response syndrome (SIRS), baseline serum creatinine, a rise in mean arterial pressure by day 3, and a reduction in the renal resistive index (ΔRRI) by day 3 of treatment. Independent predictors of HRS reversal were the presence of SIRS at baseline (P=0.022; odds ratio [OR] 15.74, 95% confidence interval [CI] 1.47-167.82) and ΔRRI ≥5% by day 3 of treatment (P=0.048; OR 6.67, 95%CI 1.021-43.62). Mean transplant-free survival at 6 months was significantly better in treatment responders (148 vs. 90 days, P<0.001). Independent predictors of 6-month mortality were response to treatment (P=0.004) and model for end-stage liver disease–sodium >23 (P=0.018).

Conclusions SIRS and ΔRRI are simple parameters to predict treatment response in HRS-AKI. Nonresponders have higher mortality and should be identified early to expedite liver transplantation.

Keywords Acute kidney injury, hepatorenal syndrome, terlipressin, systemic inflammatory response syndrome, renal resistive index

Ann Gastroenterol 2024; 37 (1): 81-88