Terlipressin and albumin for type-1 hepatorenal syndrome associated with sepsis

J Hepatol. 2014 May;60(5):955-61. doi: 10.1016/j.jhep.2013.12.032. Epub 2014 Jan 18.


Background & aims: Terlipressin and albumin is the standard of care for classical type-1 hepatorenal syndrome (HRS) not associated with active infections. However, there is no information on efficacy and safety of this treatment in patients with type-1 HRS associated with sepsis. Study aim was to investigate the effects of early treatment with terlipressin and albumin on circulatory and kidney function in patients with type-1 HRS and sepsis and assess factors predictive of response to therapy.

Methods: Prospective study in 18 consecutive patients with type-1 HRS associated with sepsis.

Results: Treatment was associated with marked improvement in arterial pressure and suppression of the high levels of plasma renin activity and norepinephrine. Response to therapy (serum creatinine <1.5mg/dl) was achieved in 12/18 patients (67%) and was associated with improved 3-month survival compared to patients without response. Non-responders had significantly lower baseline heart rate, poor liver function tests, slightly higher serum creatinine, and higher Child-Pugh and MELD scores compared to responders. Interestingly, non-responders had higher values of CLIF-SOFA score compared to responders (14±3 vs. 8±1, respectively p<0.001), indicating greater severity of acute-on-chronic liver failure (ACLF). A CLIF-SOFA score ⩾11 had 92% sensitivity and 100% specificity in predicting no response to therapy. No significant differences were observed between responders and non-responders in baseline urinary kidney biomarkers. Treatment was safe and no patient required withdrawal of terlipressin.

Conclusions: Early treatment with terlipressin and albumin in patients with type-1 HRS associated with sepsis is effective and safe. Patients with associated severe ACLF are unlikely to respond to treatment.

Keywords: Acute-on-chronic liver failure; Cirrhosis; Hepatorenal syndrome; Terlipressin.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albumins / therapeutic use*
  • Blood Pressure
  • Creatinine / blood
  • Female
  • Heart Rate
  • Hepatorenal Syndrome / complications*
  • Hepatorenal Syndrome / drug therapy*
  • Hepatorenal Syndrome / physiopathology
  • Humans
  • Kidney / physiopathology
  • Liver Failure / complications
  • Liver Failure / drug therapy
  • Liver Failure / physiopathology
  • Lypressin / analogs & derivatives*
  • Lypressin / therapeutic use
  • Male
  • Middle Aged
  • Prospective Studies
  • Sepsis / complications*
  • Sepsis / drug therapy
  • Terlipressin
  • Treatment Outcome


  • Albumins
  • Lypressin
  • Terlipressin
  • Creatinine