Background & Aims Terlipressin is indicated to treat hepatorenal syndrome (HRS)-acute kidney injury (AKI), but is likely used outside this primary indication in clinical practice. We aimed to investigate real-world practice patterns on the use of terlipressin in AKI in cirrhosis. Methods International prospective study including patients hospitalized for decompensated cirrhosis. This was a subgroup analysis of patients who received terlipressin to treat AKI. Primary outcome was AKI resolution. Secondary outcomes were respiratory failure and 28-day mortality. Results Among 1,456 patients with AKI, 243 (17%) received terlipressin. Terlipressin was predominantly administered as continuous infusion (75%). The AKI phenotype was HRS-AKI in 50%, acute tubular necrosis (ATN) in 17%, hypovolemic in 25%, other in 8%. AKI resolution occurred in 49% of the patients, and was lowest in ATN (29%), followed by HRS-AKI (51%) and hypovolemic (63%). ATN was independently associated with lack of AKI resolution (OR=2.77, 95%CI=1.24-6.54, p=0.02). De novo respiratory failure occurred in 20% of patients. There were no significant differences in amount of albumin received nor acute-on-chronic liver failure (ACLF) grade between those who did and didn’t develop respiratory failure. The presence of pneumonia independently predicted respiratory failure (OR=7.80, 95%CI=2.43-26.95, p<0.001). Mortality rate at 28 days was 36%; ATN and hospital-acquired AKI independently predicted 28-day mortality. Conclusions Terlipressin is often used for treatment of AKI outside its primary indication of HRS-AKI. Compared to patients with HRS-AKI, response to terlipressin is significantly lower in patients with ATN, in whom the risks may outweigh the benefits. Respiratory failure is common, but does not seem to be driven by the amount of albumin received nor ACLF grade.
Real-world use of terlipressin in cirrhosis and acute kidney injury: frequent use beyond hepatorenal syndrome / Ma, Ann T.; Juanola, Adrià; Patidar, Kavish R.; Barone, Anna; Incicco, Simone; Kulkarni, Anand V.; Verma, Nipun; Lange, Christian M.; Xie, Qing; Alessandria, Carlo; Reyes, Eira Cerda; Maiwall, Rakhi; Kim, Jeong Han; Marciano, Sebastián; Farias, Alberto Queiroz; Toledo, Claudio; Nardelli, Silvia; Vorobioff, Julio D.; Roblero, Juan Pablo; Thévenot, Thierry; Papp, Maria; Maan, Raoel; Solé, Cristina; Cordova-Gallardo, Jacqueline; Simonetto, Douglas A.; Fouad, Yasser; Balcar, Lorenz; Raevens, Sarah; Nabilou, Puria; Caraceni, Paolo; Merli, Manuela; Presa, José; Laleman, Wim; Krag, Aleksander; Bruns, Tony; Pereira, Gustavo; Mattos, Angelo Z.; Arab, Juan Pablo; Wentworth, Brian; Abdelkader, Nadia Abdelaaty; Wong, Yu Jun; Kim, Sung-Eun; Roux, Olivier; Takkenberg, R. Bart; Galante, Antonio; Goncalves, Luciana Lofego; Pyrsopoulos, Nikolaos T.; Pérez Hernández, José Luis; Asrani, Sumeet K.; Torre, Aldo; Díaz-Ferrer, Javier; Orman, Eric S.; Perricone, Giovanni; Gadano, Adrian; Ivashkin, Vladimir; Fassio, Eduardo; Marino, Mónica; Vargas, Victor; Rabinowich, Liane; Montes, Pedro; Mohammed, Abdulsemed; Carrera, Enrique; Cabrera, María Cecilia; Girala, Marcos; Samant, Hrishikesh; Madaleno, Joao; Kim, W. Ray; Ferreira, Carlos Noronha; Allegretti, Andrew S.; Sarin, Shiv K.; Ginès, Pere; Angeli, Paolo; Solà, Elsa; Piano, Salvatore. - (2025). [10.1016/j.cgh.2025.08.031].
Real-world use of terlipressin in cirrhosis and acute kidney injury: frequent use beyond hepatorenal syndrome
Barone, Anna;Incicco, Simone;Nardelli, Silvia;Merli, Manuela;
2025
Abstract
Background & Aims Terlipressin is indicated to treat hepatorenal syndrome (HRS)-acute kidney injury (AKI), but is likely used outside this primary indication in clinical practice. We aimed to investigate real-world practice patterns on the use of terlipressin in AKI in cirrhosis. Methods International prospective study including patients hospitalized for decompensated cirrhosis. This was a subgroup analysis of patients who received terlipressin to treat AKI. Primary outcome was AKI resolution. Secondary outcomes were respiratory failure and 28-day mortality. Results Among 1,456 patients with AKI, 243 (17%) received terlipressin. Terlipressin was predominantly administered as continuous infusion (75%). The AKI phenotype was HRS-AKI in 50%, acute tubular necrosis (ATN) in 17%, hypovolemic in 25%, other in 8%. AKI resolution occurred in 49% of the patients, and was lowest in ATN (29%), followed by HRS-AKI (51%) and hypovolemic (63%). ATN was independently associated with lack of AKI resolution (OR=2.77, 95%CI=1.24-6.54, p=0.02). De novo respiratory failure occurred in 20% of patients. There were no significant differences in amount of albumin received nor acute-on-chronic liver failure (ACLF) grade between those who did and didn’t develop respiratory failure. The presence of pneumonia independently predicted respiratory failure (OR=7.80, 95%CI=2.43-26.95, p<0.001). Mortality rate at 28 days was 36%; ATN and hospital-acquired AKI independently predicted 28-day mortality. Conclusions Terlipressin is often used for treatment of AKI outside its primary indication of HRS-AKI. Compared to patients with HRS-AKI, response to terlipressin is significantly lower in patients with ATN, in whom the risks may outweigh the benefits. Respiratory failure is common, but does not seem to be driven by the amount of albumin received nor ACLF grade.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
