Management of hepatorenal syndrome and associated outcomes: a systematic reviews

BMJ Open Gastroenterol. 2024 Apr 17;11(1):e001319. doi: 10.1136/bmjgast-2023-001319.

Abstract

Background: Hepatorenal syndrome (HRS), a multiorgan condition of acute kidney injury, is seen in advanced liver disease. This study aims to evaluate the current treatment for HRS.

Methods: The authors searched PubMed, Scopus and Google Scholar literature. After quality assessment, 31 studies were included in this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology and the population, intervention, comparison and outcome scheme were used. We included human-controlled trials that evaluate the current treatment for HRS. Two authors independently screened articles for inclusion, extracted data and assessed the quality of included studies.

Results: This study investigated the studies conducted on the effects of different treatments on follow-up of HRS patients. We gathered 440 articles, so 31 articles remained in our study. Of which 24 articles were conducted on terlipressin versus placebo or other treatments (midodrine/octreotide, norepinephrine, etc) that showed the higher rate of HRS reversal was detected for terlipressin in 17 studies (10 of them were significant), 2 studies achieved an insignificant lower rate of the model for end-stage liver disease score for terlipressin, 15 studies showed a decreased mortality rate in the terlipressin group (4 of them were significant).

Conclusion: This review showed that terlipressin has a significantly higher reversal rate of HRS than the other treatments. Even the results showed that terlipressin is more efficient than midodrine/octreotide and norepinephrine as a previous medication, in reverse HRS, increasing patient survival.

Keywords: ACUTE LIVER FAILURE; CIRRHOSIS; HEPATORENAL SYNDROME.

Publication types

  • Review

MeSH terms

  • End Stage Liver Disease*
  • Hepatorenal Syndrome* / drug therapy
  • Humans
  • Midodrine* / therapeutic use
  • Norepinephrine / therapeutic use
  • Octreotide / therapeutic use
  • Severity of Illness Index
  • Terlipressin / therapeutic use
  • Vasoconstrictor Agents / therapeutic use

Substances

  • Terlipressin
  • Vasoconstrictor Agents
  • Midodrine
  • Octreotide
  • Norepinephrine