Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.

<h4>Background</h4>Hepatorenal syndrome (HRS) is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. Norepinephrine could be an effec...

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Autores principales:	Antonio Paulo Nassar Junior, Alberto Queiroz Farias, Luiz Augusto Carneiro D' Albuquerque, Flair José Carrilho, Luiz Marcelo Sá Malbouisson
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7806a39ca9e5440e9ae1c34a92c9082b
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spelling	oai:doaj.org-article:7806a39ca9e5440e9ae1c34a92c9082b2021-11-25T06:01:18ZTerlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.1932-620310.1371/journal.pone.0107466https://doaj.org/article/7806a39ca9e5440e9ae1c34a92c9082b2014-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0107466https://doaj.org/toc/1932-6203<h4>Background</h4>Hepatorenal syndrome (HRS) is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. Norepinephrine could be an effective alternative. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of norepinephrine compared to terlipressin in the management of HRS.<h4>Methods</h4>We searched the Medline, Embase, Scopus, CENTRAL, Lilacs and Scielo databases for randomized trials of norepinephrine and terlipressin in the treatment of HRS up to January 2014. Two reviewers collected data and assessed the outcomes and risk of bias. The primary outcome was the reversal of HRS. Secondary outcomes were mortality, recurrence of HRS and adverse events.<h4>Results</h4>Four studies comprising 154 patients were included. All trials were considered to be at overall high risk of bias. There was no difference in the reversal of HRS (RR = 0.97, 95% CI = 0.76 to 1.23), mortality at 30 days (RR = 0.89, 95% CI = 0.68 to 1.17) and recurrence of HRS (RR = 0.72; 95% CI = 0.36 to 1.45) between norepinephrine and terlipressin. Adverse events were less common with norepinephrine (RR = 0.36, 95% CI = 0.15 to 0.83).<h4>Conclusions</h4>Norepinephrine seems to be an attractive alternative to terlipressin in the treatment of HRS and is associated with less adverse events. However, these findings are based on data extracted from only four small studies.Antonio Paulo Nassar JuniorAlberto Queiroz FariasLuiz Augusto Carneiro D' AlbuquerqueFlair José CarrilhoLuiz Marcelo Sá MalbouissonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 9, p e107466 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Antonio Paulo Nassar Junior Alberto Queiroz Farias Luiz Augusto Carneiro D' Albuquerque Flair José Carrilho Luiz Marcelo Sá Malbouisson Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.
description	<h4>Background</h4>Hepatorenal syndrome (HRS) is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. Norepinephrine could be an effective alternative. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of norepinephrine compared to terlipressin in the management of HRS.<h4>Methods</h4>We searched the Medline, Embase, Scopus, CENTRAL, Lilacs and Scielo databases for randomized trials of norepinephrine and terlipressin in the treatment of HRS up to January 2014. Two reviewers collected data and assessed the outcomes and risk of bias. The primary outcome was the reversal of HRS. Secondary outcomes were mortality, recurrence of HRS and adverse events.<h4>Results</h4>Four studies comprising 154 patients were included. All trials were considered to be at overall high risk of bias. There was no difference in the reversal of HRS (RR = 0.97, 95% CI = 0.76 to 1.23), mortality at 30 days (RR = 0.89, 95% CI = 0.68 to 1.17) and recurrence of HRS (RR = 0.72; 95% CI = 0.36 to 1.45) between norepinephrine and terlipressin. Adverse events were less common with norepinephrine (RR = 0.36, 95% CI = 0.15 to 0.83).<h4>Conclusions</h4>Norepinephrine seems to be an attractive alternative to terlipressin in the treatment of HRS and is associated with less adverse events. However, these findings are based on data extracted from only four small studies.
format	article
author	Antonio Paulo Nassar Junior Alberto Queiroz Farias Luiz Augusto Carneiro D' Albuquerque Flair José Carrilho Luiz Marcelo Sá Malbouisson
author_facet	Antonio Paulo Nassar Junior Alberto Queiroz Farias Luiz Augusto Carneiro D' Albuquerque Flair José Carrilho Luiz Marcelo Sá Malbouisson
author_sort	Antonio Paulo Nassar Junior
title	Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.
title_short	Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.
title_full	Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.
title_fullStr	Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.
title_full_unstemmed	Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.
title_sort	terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/7806a39ca9e5440e9ae1c34a92c9082b
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Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome: a systematic review and meta-analysis.

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