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Comparative Efficacy Of Pharmacological Strategies For Management Of Type 1 Hepatorenal Syndrome: A Systematic Review And Network Meta-analysis.

A. Facciorusso, A. Chandar, M. Murad, L. Prokop, N. Muscatiello, P. Kamath, S. Singh
Published 2017 · Medicine

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BACKGROUND Several drugs have been studied to improve outcomes for patients with hepatorenal syndrome, but trials have reported variable efficacy. We aimed to compare the efficacy of different management strategies for type 1 hepatorenal syndrome. METHODS For this systematic review and network meta-analysis, we searched Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Scopus, and Web of Science for papers published up to June 9, 2016. We selected randomised controlled trials of adults (>18 years) with decompensated cirrhosis and type 1 hepatorenal syndrome that compared the efficacy of active vasoactive drugs (terlipressin, midodrine, octreotide, noradrenaline, and dopamine; alone or in combination) with placebo or each other. The primary outcome was reduction in short-term mortality. Secondary outcomes were reversal of hepatorenal syndrome, relapse of hepatorenal syndrome after initial reversal, and adverse events. We did pairwise and network meta-analyses to produce odds ratios (ORs) and 95% CIs. We used the GRADE criteria to appraise quality of evidence. FINDINGS We identified 13 randomised controlled trials done in 739 adults with type 1 hepatorenal syndrome. All participants received supportive therapy with albumin. Moderate-quality evidence might support the use of terlipressin over placebo for reduction of short-term mortality (OR 0·65, 95% CI 0·41-1·05), whereas only low-quality evidence supported the use of noradrenaline, midodrine plus octreotide, and dopamine plus furosemide over placebo to reduce mortality, and no ORs for any of the comparisons versus placebo were significant. Moderate-quality evidence supported the use of terlipressin over midodrine plus octreotide (OR 26·25, 95% CI 3·07-224·21) to reverse hepatorenal syndrome, with low-quality evidence supporting the use of noradrenaline over placebo (4·17, 1·37-12·50) and over midodrine plus octreotide (10·00, 1·49-50·00) for this outcome. A median of 16% (range 5-20) of terlipressin-treated patients, and 33% (range 6-40) noradrenaline-treated patients with reversal of hepatorenal syndrome had recurrence on discontinuation of therapy. A median of 8% (range 4-22) terlipressin-treated patients required discontinuation of therapy due to serious adverse events. INTERPRETATION Terlipressin with albumin might reduce short-term mortality compared with placebo in patients with type 1 hepatorenal syndrome. Terlipressin with albumin and noradrenaline with albumin are both superior to midodrine plus octreotide with albumin for reversal of hepatorenal syndrome. Pragmatic clinical trials of terlipressin with albumin are warranted to evaluate real-world effectiveness and safety in patients with type 1 hepatorenal syndrome. FUNDING None.
This paper references
10.1002/hep.26359
Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012
B. Runyon (2013)
10.1046/j.1440-1746.2003.02934.x
Beneficial effects of terlipressin in hepatorenal syndrome: A prospective, randomized placebo‐controlled clinical trial
P. Solanki (2003)
10.1016/J.JCEH.2013.02.242
Noradrenaline is equally effective as terlipressin in reversal of type 1 hepatorenal syndrome: A randomized prospective study
Reyaz Ahmad Indrabi (2013)
10.7326/M14-2385
The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions: Checklist and Explanations
B. Hutton (2015)
10.1136/bmj.d5928
The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials
J. P. Higgins (2011)
10.1016/S0168-8278(98)80151-7
Beneficial effects of the 2‐day administration of terlipressin in patients with cirrhosis and hepatorenal syndrome
A. Hadengue (1998)
10.1002/hep.23286
Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome
L. Gluud (2010)
10.1136/bmj.g5630
A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis
M. Puhan (2014)
10.1016/j.jhep.2012.01.012
Noradrenaline vs. terlipressin in the treatment of hepatorenal syndrome: a randomized study.
V. Singh (2012)
10.1002/jrsm.1045
Consistency and inconsistency in network meta-analysis: model estimation using multivariate meta-regression‡
I. White (2012)
10.1016/j.jval.2011.04.002
Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1.
J. Jansen (2011)
10.1056/NEJMra0809139
Renal failure in cirrhosis.
P. Ginès (2009)
10.1053/j.gastro.2016.02.026
Terlipressin Plus Albumin Is More Effective Than Albumin Alone in Improving Renal Function in Patients With Cirrhosis and Hepatorenal Syndrome Type 1.
T. Boyer (2016)
10.1136/bmj.327.7414.557
Measuring inconsistency in meta-analyses
J. Higgins (2003)
Noradrenalin Versus the Combination of Midodrine and Octreotide in Patients with Hepatorenal Syndrome: Randomized Clinical Trial
H. Tavakkoli (2012)
10.1016/j.jhep.2010.05.004
EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.
S. Møller (2010)
10.1016/0197-2456(86)90046-2
Meta-analysis in clinical trials.
R. Dersimonian (1986)
10.1002/hep.20687
MELD score and clinical type predict prognosis in hepatorenal syndrome: Relevance to liver transplantation
C. Alessandria (2005)
10.1002/hep.27709
Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial
M. Cavallin (2015)
10.7326/0003-4819-159-2-201307160-00008
Conceptual and Technical Challenges in Network Meta-analysis
A. Cipriani (2013)
10.1007/s10620-007-9919-9
Terlipressin and Albumin in Patients with Cirrhosis and Type I Hepatorenal Syndrome
S. Neri (2007)
10.1111/j.1572-0241.2008.01828.x
An Open Label, Pilot, Randomized Controlled Trial of Noradrenaline Versus Terlipressin in the Treatment of Type 1 Hepatorenal Syndrome and Predictors of Response
P. Sharma (2008)
10.1016/J.JHEP.2007.04.010
Noradrenalin vs terlipressin in patients with hepatorenal syndrome: a prospective, randomized, unblinded, pilot study.
C. Alessandria (2007)
10.1016/j.jclinepi.2012.01.006
GRADE guidelines: 11. Making an overall rating of confidence in effect estimates for a single outcome and for all outcomes.
G. Guyatt (2013)
10.1002/hep.28396
Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study
M. Cavallin (2016)
10.1136/bmj.315.7109.629
Bias in meta-analysis detected by a simple, graphical test
M. Egger (1997)
10.1053/j.gastro.2008.02.014
A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome.
A. Sanyal (2008)
10.1053/j.gastro.2008.02.024
Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study.
M. Martín-Llahí (2008)
10.1016/j.jceh.2015.08.003
Randomized Controlled Trial Comparing the Efficacy of Terlipressin and Albumin with a Combination of Concurrent Dopamine, Furosemide, and Albumin in Hepatorenal Syndrome.
Siddharth Srivastava (2015)
10.1016/j.jclinepi.2011.01.012
GRADE guidelines 6. Rating the quality of evidence--imprecision.
G. Guyatt (2011)



This paper is referenced by
10.1007/s12072-020-10018-0
Acute kidney injury: prediction, prognostication and optimisation for liver transplant
N. Jagarlamudi (2020)
10.1080/17474124.2019.1644167
Primary and secondary prophylaxis of spontaneous bacterial peritonitis: current state of the art
A. Facciorusso (2019)
10.1080/03007995.2018.1552575
Terlipressin for the treatment of hepatorenal syndrome: an overview of current evidence
J. Zhang (2019)
10.12659/AJCR.913150
Terlipressin-Induced Peripheral Cyanosis in a Patient with Liver Cirrhosis and Hepatorenal Syndrome
Chi-Wen Chiang (2019)
10.3748/wjg.v25.i28.3684
Acute kidney injury spectrum in patients with chronic liver disease: Where do we stand?
W. Chancharoenthana (2019)
10.7326/AITC201711070
Acute Kidney Injury
A. Levey (2017)
10.1002/cld.813
Clinical Consequences of Infection in Cirrhosis: Organ Failures and Acute‐on‐Chronic Liver Failure
F. Wong (2019)
10.1016/j.semnephrol.2018.10.002
Epidemiology, Pathophysiology, and Management of Hepatorenal Syndrome.
A. A. Amin (2019)
10.2147/TCRM.S205328
Hepatorenal Syndrome Type 1: Current Challenges And Future Prospects
A. Facciorusso (2019)
10.1111/liv.13893
Hepatorenal syndrome in the era of acute kidney injury
C. Solé (2018)
10.1007/978-3-030-24432-3_55
Endoscopic and Pharmacological Treatment of Esophageal Varices
A. Facciorusso (2020)
10.21037/tgh.2018.08.02
A systematic review and meta-analysis of treatment for hepatorenal syndrome with traditional Chinese medicine.
Tingxue Song (2018)
10.1097/MD.0000000000010431
Terlipressin in the treatment of hepatorenal syndrome
H. Wang (2018)
10.1007/s10620-019-05858-2
Limited Progress in Hepatorenal Syndrome (HRS) Reversal and Survival 2002–2018: A Systematic Review and Meta-Analysis
Mary J. Thomson (2019)
10.1016/j.jhep.2019.07.002
News in Pathophysiology, Definition and Classification of Hepatorenal Syndrome: a step beyond the International Club of Ascites (ICA) Consensus document.
P. Angeli (2019)
10.1080/17474124.2020.1708190
Diagnosis and management of renal dysfunction in patients with cirrhosis
A. Carrion (2019)
10.1016/j.accpm.2019.06.014
Management of liver failure in General Intensive Care Unit.
E. Weiss (2019)
10.3350/cmh.2018.1005
KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications
Yong-Han Paik (2018)
10.1111/aor.13532
Intermittent high-flux albumin dialysis with continuous venovenous hemodialysis for acute-on-chronic liver failure and acute kidney injury.
G. Niewiński (2019)
10.1007/s10620-018-5092-6
Nonselective Beta-Blockers Do Not Affect Survival in Cirrhotic Patients with Ascites
A. Facciorusso (2018)
10.4166/kjg.2018.72.2.64
[Acute Kidney Injury and Hepatorenal Syndrome].
M. Y. Kim (2018)
10.1016/J.MED.2019.05.021
Insuficiencia renal aguda (II). Tratamiento. Terapia renal sustitutiva. Situaciones especiales. Ancianos. Insuficiencia cardíaca. Cirrosis
R. Ojeda López (2019)
TCRM_A_205328 1383..1391
A. Facciorusso (2019)
10.1007/s11938-020-00292-0
Latest Treatment of Acute Kidney Injury in Cirrhosis
F. Wong (2020)
10.1177/0885066618790558
Acute Kidney Injury Before and After Liver Transplant
Jeffrey Dellavolpe (2018)
10.1097/MCG.0000000000000913
Pharmacological Therapies for Hepatorenal Syndrome: A Systematic Review and Meta-Analysis
Arjun Nanda (2018)
10.1111/liv.14109
Comparative efficacy of long‐term antibiotic treatments in the primary prophylaxis of spontaneous bacterial peritonitis
A. Facciorusso (2019)
10.1016/J.CLD.2019.06.002
Ascites and Hepatorenal Syndrome.
D. Adebayo (2019)
10.1016/S2468-1253(16)30211-4
Terlipressin for hepatorenal syndrome: ready for prime time.
P. Ginès (2017)
10.21518/2079-701x-2020-5-62-69
Role of human albumin in the management of liver cirrhosis
M. Maevskaya (2020)
10.1007/s00330-020-07259-w
Haemodynamic changes in cirrhosis following terlipressin and induction of sepsis—a preclinical study using caval subtraction phase-contrast and cardiac MRI
M. Chouhan (2020)
COMPARISON OF EFFICACY ON NORADRENALINE AND TERLIPRESSIN IN HEPATORENAL SYNDROME IN THE PATIENTS OF DECOMPENSATED CIRRHOSIS – A RANDOMIZED CONTROLLED STUDY
M. K. Siddique (2019)
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