PDF(Pubmed)
Abstract：
UNASSIGNED: Despite having ample literature in hepatorenal syndrome-acute kidney injury (HRS-AKI) in decompensated cirrhosis patients, there is a scarcity of data on acute-on-chronic liver failure-acute kidney injury (ACLF-AKI). We compared terlipressin infusion with bolus in ACLF-AKI patients.
UNASSIGNED: Patients with ACLF (as per the CANONIC study) were screened for AKI as per the 2015 ICA-AKI criteria. If after 48 h of volume expansion with albumin, serum creatinine (sCr) did not improve, patients were randomized into two groups: Terli-infusion (Terli-I) 2 mg/day and Terli-bolus (Terli-B) 1 mg q6h. If sCr did not decrease < 25% of pretreatment value after 48 h, the terlipressin dose was increased to a maximum of 12 mg/day. The primary outcome was taken as regression (full or partial response), stable/no response and progression of AKI to higher stages and secondary outcomes were taken as 28-day and 90-day mortality.
UNASSIGNED: After screening 136 patients with ACLF-AKI, Terli-I (n = 50) and Terli-B (n = 50) with mean sCr 2.4 and 2.1 mg/dl respectively were enrolled. The regression of AKI (full response 37 vs. 27, partial response 3 vs. 9, p = 0.5), stable (2 vs. 5, p = 0.6), progression of AKI (8 vs. 7, p = 0.2) were present in Terli-I and Terli-B respectively. No significant difference was found in 28-and 90-day mortality. In Terli-B, mean terlipressin dose was 8 vs. 4 mg, p < 0.008 with more side effects, 15 vs. 0, p < 0.01 than Terli-I respectively.
UNASSIGNED: Terlipressin infusion is more effective than bolus doses in regression of acute kidney injury and better tolerated in acute-on-chronic liver failure-AKI patients.
UNASSIGNED: Patients with ACLF (as per the CANONIC study) were screened for AKI as per the 2015 ICA-AKI criteria. If after 48 h of volume expansion with albumin, serum creatinine (sCr) did not improve, patients were randomized into two groups: Terli-infusion (Terli-I) 2 mg/day and Terli-bolus (Terli-B) 1 mg q6h. If sCr did not decrease < 25% of pretreatment value after 48 h, the terlipressin dose was increased to a maximum of 12 mg/day. The primary outcome was taken as regression (full or partial response), stable/no response and progression of AKI to higher stages and secondary outcomes were taken as 28-day and 90-day mortality.
UNASSIGNED: After screening 136 patients with ACLF-AKI, Terli-I (n = 50) and Terli-B (n = 50) with mean sCr 2.4 and 2.1 mg/dl respectively were enrolled. The regression of AKI (full response 37 vs. 27, partial response 3 vs. 9, p = 0.5), stable (2 vs. 5, p = 0.6), progression of AKI (8 vs. 7, p = 0.2) were present in Terli-I and Terli-B respectively. No significant difference was found in 28-and 90-day mortality. In Terli-B, mean terlipressin dose was 8 vs. 4 mg, p < 0.008 with more side effects, 15 vs. 0, p < 0.01 than Terli-I respectively.
UNASSIGNED: Terlipressin infusion is more effective than bolus doses in regression of acute kidney injury and better tolerated in acute-on-chronic liver failure-AKI patients.
摘要：
■尽管在失代偿期肝硬化患者的肝肾综合征-急性肾损伤（HRS-AKI）中有大量文献，关于慢性急性肝衰竭-急性肾损伤(ACLF-AKI)的数据很少.我们在ACLF-AKI患者中比较了特利加压素输注和推注。
■ACLF患者（根据CANONIC研究）根据2015年ICA-AKI标准进行AKI筛查。如果在用白蛋白进行48小时的体积膨胀后，血清肌酐（sCr）没有改善，患者被随机分为两组:Terli输注(Terli-I)2mg/d和Terli-bolus(Terli-B)1mgq6h.如果sCr在48h后没有降低<预处理值的25%，特利加压素的最大剂量增加至12mg/天.主要结果为回归（完全或部分反应），将AKI的稳定/无反应和进展至更高阶段和次要结局作为28日和90日死亡率.
■在筛查136名ACLF-AKI患者后，分别纳入平均sCr2.4和2.1mg/dl的Terli-I（n=50）和Terli-B（n=50）。AKI的回归(全反应37vs.27，部分反应3vs.9，p=0.5），稳定(2vs.5，p=0.6），AKI进展（8vs.7，p=0.2）分别存在于Terli-I和Terli-B中。在28天和90天的死亡率中没有发现显着差异。在Terli-B,平均特利加压素剂量为8vs.4毫克，p<0.008，副作用更多，15vs.0,p分别比Terli-I<0.01。
■特利加压素输注在急性肾损伤的消退方面比推注剂量更有效，并且在慢性急性肝衰竭-AKI患者中耐受性更好。
■ACLF患者（根据CANONIC研究）根据2015年ICA-AKI标准进行AKI筛查。如果在用白蛋白进行48小时的体积膨胀后，血清肌酐（sCr）没有改善，患者被随机分为两组:Terli输注(Terli-I)2mg/d和Terli-bolus(Terli-B)1mgq6h.如果sCr在48h后没有降低<预处理值的25%，特利加压素的最大剂量增加至12mg/天.主要结果为回归（完全或部分反应），将AKI的稳定/无反应和进展至更高阶段和次要结局作为28日和90日死亡率.
■在筛查136名ACLF-AKI患者后，分别纳入平均sCr2.4和2.1mg/dl的Terli-I（n=50）和Terli-B（n=50）。AKI的回归(全反应37vs.27，部分反应3vs.9，p=0.5），稳定(2vs.5，p=0.6），AKI进展（8vs.7，p=0.2）分别存在于Terli-I和Terli-B中。在28天和90天的死亡率中没有发现显着差异。在Terli-B,平均特利加压素剂量为8vs.4毫克，p<0.008，副作用更多，15vs.0,p分别比Terli-I<0.01。
■特利加压素输注在急性肾损伤的消退方面比推注剂量更有效，并且在慢性急性肝衰竭-AKI患者中耐受性更好。
