Noradrenaline vs terlipressin in the treatment of type 2 hepatorenal syndrome: a randomized pilot study

Liver Int. 2013 Sep;33(8):1187-93. doi: 10.1111/liv.12179. Epub 2013 Apr 21.


Background: Various vasoconstrictors have shown promising results in the management of type 1 hepatorenal syndrome (HRS). However, there are very few studies on vasopressors in the management of type 2 HRS. Terlipressin has been used commonly; however, it is costly and not available in some countries. In this study, we evaluated the safety and efficacy of terlipressin and noradrenaline in the treatment of type 2 HRS.

Methods: Forty-six patients with type 2 HRS were managed with terlipressin (group A, N = 23) or noradrenaline (Group B, N = 23) with albumin in a randomized controlled trial at a tertiary centre.

Results: HRS reversal could be achieved in 17(73.9%) patients in group A as well as in group B (P = 1.0). Univariate analysis showed that the baseline model of end-stage liver disease score, urine output, urinary sodium, serum creatinine and mean arterial pressure were associated with response. However, in multivariate analysis only baseline serum creatinine, urine output and urinary sodium were associated with the response. Eight patients in group A and 9 in group B died within 90 days of follow-up (P > 0.05). Noradrenaline was less expensive than terlipressin (P < 0.05). No major adverse effects were seen.

Conclusions: The results of this randomized study suggest that terlipressin and noradrenaline are safe and effective in the treatment of type 2 HRS and baseline serum creatinine, urine output and urinary sodium are predictive of response. Noradrenaline is less expensive than terlipressin in the treatment of type 2 HRS (, Number NCT01637454).

Keywords: Ascites; renal dysfunction; splanchnic vasodilatation; vasopressor.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Biomarkers / blood
  • Biomarkers / urine
  • Chi-Square Distribution
  • Creatinine / blood
  • Female
  • Hemodynamics / drug effects*
  • Hepatorenal Syndrome / diagnosis
  • Hepatorenal Syndrome / drug therapy*
  • Hepatorenal Syndrome / metabolism
  • Hepatorenal Syndrome / physiopathology
  • Humans
  • India
  • Kaplan-Meier Estimate
  • Logistic Models
  • Lypressin / adverse effects
  • Lypressin / analogs & derivatives*
  • Lypressin / therapeutic use
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Norepinephrine / adverse effects
  • Norepinephrine / therapeutic use*
  • Pilot Projects
  • Sodium / urine
  • Terlipressin
  • Tertiary Care Centers
  • Time Factors
  • Treatment Outcome
  • Urination
  • Vasoconstrictor Agents / adverse effects
  • Vasoconstrictor Agents / therapeutic use*


  • Biomarkers
  • Vasoconstrictor Agents
  • Lypressin
  • Terlipressin
  • Sodium
  • Creatinine
  • Norepinephrine

Associated data