- Email: [email protected]
Study on the Predictors of Response to Terlipressin Plus Albumin in Hepatorenal Syndrome (HRS) Type 1
CIRRHOSIS AND COMPLICATIONS
Cirrhosis and Complications
with malnutrition were analyzed using univariate analysis. Results: 44 patients with cirrhosis of liver between February and April 2016 were included. The mean age was 52 (13.8) years and 81.8% (36) were males with a median BMI of 24 (16–36) kg/m2. HBV was the most common etiology in 40.9% (18) cases. 18.2%, 59.1% and 22.7% were in CTP class A, B and C respectively. Low MUAC was prevalent in 31.8% (14/44) and low TSF was present in 71.7% (32/44) patients. Alcoholic etiology (57% vs 20%; P = 0.03) and protein restriction (92.8% vs 63.3%; P = 0.06) were associated with low MUAC. Vegetarian diet (68.6% vs 16.6%; P = 0.005) was associated with low TSF. Proportion of patients with low MUAC or low TSF were equally distributed in the CTP categories (P = 0.15 and 0.70 respectively). The nutrient intake was also similar between the CTP categories. Conclusion: Significant proportion of Indian cirrhotics, irrespective of severity have high prevalence of malnutrition. Alcoholic etiology, protein restriction and vegetarian diet are associated with markers of poor nutrition. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Kaushal Madan. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.100
34 STUDY ON THE PREDICTORS OF RESPONSE TO TERLIPRESSIN PLUS ALBUMIN IN HEPATORENAL SYNDROME (HRS) TYPE 1 Manasa, Girinadh, Muralikrishna Manne, Kaibalya R. Dash King George Hospital, Vishakapatnam, India
Background and Aim: Terlipressin plus albumin is an effective treatment for type 1 hepatorenal syndrome (HRS), but approximately only half of the patients respond to this therapy. The aim of this study was to assess predictive factors of response to treatment with terlipressin and albumin in patients with type 1 HRS. Methods: Thirty patients with cirrhosis and type 1 HRS were treated prospectively with terlipressin and albumin. Demographic, clinical, laboratory variables S52
and beta blocker usage were obtained before the initiation of treatment as well as changes in arterial pressure during treatment were analyzed for their predictive value. Results: Response to therapy (reduction in serum creatinine <1.5 mg/dL at the end of treatment) was observed in 12 patients (40%) and was associated with an improvement in circulatory function. Independent predictive factors of response to therapy were baseline serum bilirubin, baseline serum creatinine, and an increase in mean arterial pressure of 5 mm Hg at day 3 of treatment. The cutoff level of serum bilirubin that best predicted response to treatment was 8 mg/ dL (area under the receiver operating characteristic curve, 0.61; P < 0.001; sensitivity, 89%; specificity, 61%). The cutoff level of serum creatinine that best predicted response to treatment was 3 mg/dL (area under the receiver operating characteristic curve, 0.72; P < 0.012; sensitivity, 85%; specificity, 62%). Corresponding values in patients with an increase in mean arterial pressure 5 mm Hg or <5 mm Hg at day 3 were 64% and 23%, respectively. Previous use of beta blockers is not associated with response to treatment. Conclusion: Serum bilirubin, serum creatinine and an early increase in arterial pressure predict response to treatment with terlipressin and albumin in type 1 HRS. No role of beta blockers in predicting response to treatment. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Kaibalya R. Dash. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.101
35 INFLUENCE OF BETA BLOCKERS ON COMPLICATIONS OF CIRRHOSIS Kayalvizhi Rajini, T. Rajkumar Solomon, Aravind Arumugham, Murali Ananthavadivelu, Balamurali Rangachari, Muthukumaran Kalyanasundaram, Ramkumar Govindarajan, C. Vaishnavi Priyaa, S. Kavitha Kilpauk Medical College, Chennai, Tamilnadu, India
Background and Aim: Non-selective beta blockers (NSBB) are said to be protective against spontaneous bacterial peritonitis and worsen hepatorenal syndrome, refractory ascites and hepatic encephalopathy © 2016, INASL
Cirrhosis and Complications
with malnutrition were analyzed using univariate analysis. Results: 44 patients with cirrhosis of liver between February and April 2016 were included. The mean age was 52 (13.8) years and 81.8% (36) were males with a median BMI of 24 (16–36) kg/m2. HBV was the most common etiology in 40.9% (18) cases. 18.2%, 59.1% and 22.7% were in CTP class A, B and C respectively. Low MUAC was prevalent in 31.8% (14/44) and low TSF was present in 71.7% (32/44) patients. Alcoholic etiology (57% vs 20%; P = 0.03) and protein restriction (92.8% vs 63.3%; P = 0.06) were associated with low MUAC. Vegetarian diet (68.6% vs 16.6%; P = 0.005) was associated with low TSF. Proportion of patients with low MUAC or low TSF were equally distributed in the CTP categories (P = 0.15 and 0.70 respectively). The nutrient intake was also similar between the CTP categories. Conclusion: Significant proportion of Indian cirrhotics, irrespective of severity have high prevalence of malnutrition. Alcoholic etiology, protein restriction and vegetarian diet are associated with markers of poor nutrition. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Kaushal Madan. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.100
34 STUDY ON THE PREDICTORS OF RESPONSE TO TERLIPRESSIN PLUS ALBUMIN IN HEPATORENAL SYNDROME (HRS) TYPE 1 Manasa, Girinadh, Muralikrishna Manne, Kaibalya R. Dash King George Hospital, Vishakapatnam, India
Background and Aim: Terlipressin plus albumin is an effective treatment for type 1 hepatorenal syndrome (HRS), but approximately only half of the patients respond to this therapy. The aim of this study was to assess predictive factors of response to treatment with terlipressin and albumin in patients with type 1 HRS. Methods: Thirty patients with cirrhosis and type 1 HRS were treated prospectively with terlipressin and albumin. Demographic, clinical, laboratory variables S52
and beta blocker usage were obtained before the initiation of treatment as well as changes in arterial pressure during treatment were analyzed for their predictive value. Results: Response to therapy (reduction in serum creatinine <1.5 mg/dL at the end of treatment) was observed in 12 patients (40%) and was associated with an improvement in circulatory function. Independent predictive factors of response to therapy were baseline serum bilirubin, baseline serum creatinine, and an increase in mean arterial pressure of 5 mm Hg at day 3 of treatment. The cutoff level of serum bilirubin that best predicted response to treatment was 8 mg/ dL (area under the receiver operating characteristic curve, 0.61; P < 0.001; sensitivity, 89%; specificity, 61%). The cutoff level of serum creatinine that best predicted response to treatment was 3 mg/dL (area under the receiver operating characteristic curve, 0.72; P < 0.012; sensitivity, 85%; specificity, 62%). Corresponding values in patients with an increase in mean arterial pressure 5 mm Hg or <5 mm Hg at day 3 were 64% and 23%, respectively. Previous use of beta blockers is not associated with response to treatment. Conclusion: Serum bilirubin, serum creatinine and an early increase in arterial pressure predict response to treatment with terlipressin and albumin in type 1 HRS. No role of beta blockers in predicting response to treatment. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Kaibalya R. Dash. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.101
35 INFLUENCE OF BETA BLOCKERS ON COMPLICATIONS OF CIRRHOSIS Kayalvizhi Rajini, T. Rajkumar Solomon, Aravind Arumugham, Murali Ananthavadivelu, Balamurali Rangachari, Muthukumaran Kalyanasundaram, Ramkumar Govindarajan, C. Vaishnavi Priyaa, S. Kavitha Kilpauk Medical College, Chennai, Tamilnadu, India
Background and Aim: Non-selective beta blockers (NSBB) are said to be protective against spontaneous bacterial peritonitis and worsen hepatorenal syndrome, refractory ascites and hepatic encephalopathy © 2016, INASL