Early Versus Standard Initiation of Terlipressin for Acute Kidney Injury in ACLF: A Randomized Controlled Trial (eTerli Study)
Background and Aims Terlipressin infusion is effective in hepatorenal syndrome (HRS-AKI). However, its efficacy for HRS-AKI resolution in acute-on-chronic liver failure (ACLF) patients has been suboptimal. Progression of AKI is rapid in ACLF. We investigated whether early initiation of terlipressin(...
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Veröffentlicht in: | Digestive diseases and sciences 2024-06, Vol.69 (6), p.2204-2214 |
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Hauptverfasser: | , , , , , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
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Zusammenfassung: | Background and Aims
Terlipressin infusion is effective in hepatorenal syndrome (HRS-AKI). However, its efficacy for HRS-AKI resolution in acute-on-chronic liver failure (ACLF) patients has been suboptimal. Progression of AKI is rapid in ACLF. We investigated whether early initiation of terlipressin(eTerli) can improve response rates.
Methods
Consecutive ACLF patients with stage II/III AKI despite albumin resuscitation (40 g) were randomized to receive terlipressin at 2 mg/24 h plus albumin at 12 h (
ET
,
n
= 35) or at 48 h as standard therapy (
ST
,
n
= 35). (June 22, 2020 to June 10, 2022). The primary end-point was AKI reversal by day7.
Results
Baseline parameters including AKI stage and ACLF-AARC scores in two arms were comparable. Full AKI response at day 7 was higher in ET [24/35 (68.6%)] than ST arm [11/35 (31.4%;
P
0.03]. Day3 AKI response was also higher in ET arm [11/35 (31.4%) vs. 4/35 (11.4%),
P
0.04]. Using ST compared to ET [HR 4.3;
P
0.026] and day 3 serum creatinine > 1.6 mg/dl [HR 9.1; AUROC-0.866;
P
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ISSN: | 0163-2116 1573-2568 1573-2568 |
DOI: | 10.1007/s10620-024-08423-8 |