Treatment of Hepatorenal Syndrome Octreotide Vs Octreotide Vs Norepinephrine As Part of Triple Therapy,
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- Category: Vol. 84, March 2016
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Treatment of Hepatorenal Syndrome Octreotide Vs Octreotide Vs Norepinephrine As Part of Triple Therapy, OSMAN M. OSMAN, FAHIM RAGAB, MOHAMED EL-SHAFIE and AYMAN MOHARRAM
Abstract
Aims: The aim was to compare the effectiveness of oct-reotide versus midodrine versus norepinephrine in the treatment of HRS in a randomized controlled trial.
Methods and Results: Thirty patients were randomized into 3 groups: Group A received 10-15mg TDS oral midodrine, Group B received 50mg subcutaneous octreotide three times daily and Group C received a continuous infusion of Norad-renaline (NA) at an initial dose of 0.5mg/h, designed to achieve an increase in Mean Arterial Pressure (MAP) of at least 10mmHg or an increase in 4-hour urine output to more than 200mL. When one of these goals was not reached, the NA dose was increased every 4 hours in steps of 0.5mg/h, up to the maximum dose of 3mg/h. Only the Noradrenaline group showed a statistically significant increase in creatinine clear-ance at the end of treatment period. The mean creatinine clearance increased from a baseline of 35.2±7.7ml/min to 59.2±13.8ml/min in the last day of treatment. In the Norad-renaline group, reversal of hepatorenal syndrome was reached in 6 patients out of 10 (60%) with achieved serum creatinine of 1.5mg/dl or less. The goal was achieved after 3 days of treatment in ICU in only 2 patients, the other 4 needed to continue treatment till day 5, in the midodrine group, hepato-renal syndrome was reversed in only 2 patients out of 10 (20%) after 5 days of treatment. In the octreotide group, only 3 patients out of 10 showed reversal of hepatorenal syndrome (30%) after 5 days of treatment.
Conclusion: The use of Noradrenaline combined with albumin remains an effective treatment for HRS. Noradrenaline is the best alternative for Terlipressin as splanchnic vasocon-strictor with almost similar efficacy and safety profile but better as regard the financial cost. The addition of dopamine infusion to Midodrine or octreotide combined with albumin infusion did not result in significant increase in their efficacy, remaining inferior to Noradrenaline.