Terlipressin May Decrease In-Hospital Mortality of Cirrhotic Patients with Acute Gastrointestinal Bleeding and Renal Dysfunction: A Retrospective Multicenter Observational Study

• Published in: Advances in therapy Vol. 37; no. 10; pp. 4396 - 4413
• Main Authors: Xu, Xiangbo, Liu, Bang, Lin, Su, Li, Bimin, Wu, Yunhai, Li, Yiling, Zhu, Qiang, Yang, Yida, Tang, Shanhong, Meng, Fanping, Chen, Yu, Yuan, Shanshan, Shao, Lichun, Bernardi, Mauro, Yoshida, Eric M., Qi, Xingshun
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.10.2020
• Subjects: Cardiology; Endocrinology; Gastrointestinal Hemorrhage; Health technology assessment; Hospital Mortality; Humans; Internal Medicine; Liver Cirrhosis - complications; Medicine; Medicine & Public Health; Oncology; Original Research; Pharmacology/Toxicology; Retrospective Studies; Rheumatology; Terlipressin; Cirrhosis; Renal function; Gastrointestinal bleeding; Kidney injury; Survival
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-020-01466-z

Background Acute gastrointestinal bleeding (GIB) rapidly reduces effective blood volume, thereby precipitating acute kidney injury (AKI). Terlipressin, which can induce splanchnic vasoconstriction and increase renal perfusion, has been recommended for acute GIB and hepatorenal syndrome in liver cirrhosis. Thus, we hypothesized that terlipressin might be beneficial for cirrhotic patients with acute GIB and renal impairment. Methods In this Chinese multi-center study, 1644 cirrhotic patients with acute GIB were retrospectively enrolled. AKI was defined according to the International Club of Ascites (ICA) criteria. Renal dysfunction was defined as serum creatinine (sCr) > 133 μmol/L at admission and/or any time point during hospitalization. Incidence of renal impairment and in-hospital mortality were the primary end-points. Results The incidence of any stage ICA-AKI, ICA-AKI stages 1B, 2, and 3, and renal dysfunction in cirrhotic patients with acute GIB was 7.1%, 1.8%, and 5.0%, respectively. The in-hospital mortality was significantly increased by renal dysfunction (14.5% vs. 2.2%, P  < 0.001) and ICA-AKI stages 1B, 2, and 3 (11.1% vs. 2.8%, P  = 0.011), but not any stage ICA-AKI (5.7% vs. 2.7%, P  = 0.083). The in-hospital mortality was significantly decreased by terlipressin in patients with renal dysfunction (3.6% vs. 20.0%, P  = 0.044), but not in those with any stage ICA-AKI (4.5% vs. 6.0%, P  = 0.799) or ICA-AKI stages 1B, 2, and 3 (0.0% vs. 14.3%, P  = 0.326). Conclusion Renal dysfunction increased the in-hospital mortality of cirrhotic patients with acute GIB. Terlipressin might decrease the in-hospital mortality of cirrhotic patients with acute GIB and renal dysfunction. Trial Registration NCT03846180 ( https://clinicaltrials.gov ).