๐ This research is a post hoc analysis of the CONFIRM trial, focusing on the use of terlipressin in ICU patients with hepatorenal syndrome-acute kidney injury (HRS-AKI). ๐
๐ฅ Of the 300 patients randomized in the original CONFIRM study, 31 of the 199 patients in the terlipressin group and 14 of the 101 in the placebo group received ICU care. ๐ฅ
๐ The primary endpoints were changes in renal function, the need for organ support such as renal replacement therapy (RRT), and ICU length of stay (LOS). ๐ฏ
๐ Patients in the terlipressin group had larger improvements in renal function compared to the placebo group (-0.7 vs +0.2mg/dL; p = 0.001). ๐
๐งช The need for RRT was not significantly different between the two groups (10/31 (32%) in terlipressin vs. 8/14 (57%) in placebo; p = 0.12). ๐
๐จ ICU survivors from the terlipressin group had a shorter ICU LOS compared to the placebo group (4 vs. 11 days; p < 0.001). ๐ฐ๏ธ
๐ก Terlipressin, though potentially effective in high-risk subgroups, may cause serious respiratory failure. Its use should be carefully evaluated considering patient's condition. Patients with hypoxia, volume overload, or severe liver failure, and those with serum creatinine over 5 mg/dL, are not recommended to use terlipressin. Pregnant women should avoid it due to embryo fetal toxicity potential. ๐คฐ
๐ Summary: The study reveals that terlipressin treatment in ICU patients with HRS-AKI is associated with significant improvements in renal function and shorter ICU LOS, but its use should be carefully evaluated considering patient condition and potential side effects.
#HepatorenalSyndrome #AcuteKidneyInjury #Terlipressin #RenalFunction #ICULengthOfStay
Karvellas CJ, Subramanian R, Olson JC, Jamil K. Role of Terlipressin in Patients With Hepatorenal Syndrome-Acute Kidney Injury Admitted to the ICU: A Substudy of the CONFIRM Trial. Crit Care Explor. 2023 Mar 28;5(4):e0890. doi: 10.1097/CCE.0000000000000890. PMID: 37007903; PMCID: PMC10060094.