Terlipressin versus Norepinephrine in the Treatment of Hepatorenal Syndrome: A Systematic Review and Meta-Analysis

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorNASSAR JUNIOR, Antonio Paulo
dc.contributor.authorFARIAS, Alberto Queiroz
dc.contributor.authorALBUQUERQUE, Luiz Augusto Carneiro d'
dc.contributor.authorCARRILHO, Flair Jose
dc.contributor.authorMALBOUISSON, Luiz Marcelo Sa
dc.date.accessioned2015-02-06T19:42:25Z
dc.date.available2015-02-06T19:42:25Z
dc.date.issued2014
dc.description.abstractBackground: 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. Methods: 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. Results: 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). Conclusions: 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.
dc.description.indexMEDLINE
dc.identifier.citationPLOS ONE, v.9, n.9, article ID e107466, 7p, 2014
dc.identifier.doi10.1371/journal.pone.0107466
dc.identifier.issn1932-6203
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/8451
dc.language.isoeng
dc.publisherPUBLIC LIBRARY SCIENCE
dc.relation.ispartofPlos One
dc.rightsopenAccess
dc.rights.holderCopyright PUBLIC LIBRARY SCIENCE
dc.subject.othercontrolled-trial
dc.subject.othercirrhosis
dc.subject.othernoradrenaline
dc.subject.otherpilot
dc.subject.otheralbumin
dc.subject.otherpredictors
dc.subject.otherdiagnosis
dc.subject.othersurvival
dc.subject.otherascites
dc.subject.wosMultidisciplinary Sciences
dc.titleTerlipressin versus Norepinephrine in the Treatment of Hepatorenal Syndrome: A Systematic Review and Meta-Analysis
dc.typearticle
dc.type.categoryreview
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus107
hcfmusp.contributor.author-fmusphcANTONIO PAULO NASSAR JUNIOR
hcfmusp.contributor.author-fmusphcALBERTO QUEIROZ FARIAS
hcfmusp.contributor.author-fmusphcLUIZ AUGUSTO CARNEIRO D ALBUQUERQUE
hcfmusp.contributor.author-fmusphcFLAIR JOSE CARRILHO
hcfmusp.contributor.author-fmusphcLUIZ MARCELO SA MALBOUISSON
hcfmusp.description.articlenumbere107466
hcfmusp.description.issue9
hcfmusp.description.volume9
hcfmusp.origemWOS
hcfmusp.origem.scopus2-s2.0-84925808474
hcfmusp.origem.wosWOS:000342684500103
hcfmusp.publisher.citySAN FRANCISCO
hcfmusp.publisher.countryUSA
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Artigos e Materiais de Revistas Científicas - FM/MGT
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/07
Artigos e Materiais de Revistas Científicas - LIM/08
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