Endothelin-1/Nitric Oxide Ratio as a Predictive Factor of Response to Therapy With Terlipressin and Albumin in Patients With Type-1 Hepatorenal Syndrome

• Main Authors: Ahmed Abdel-Razik (Author), Nasser Mousa (Author), Mostafa Abdelsalam (Author), Ahmed Abdelwahab (Author), Mona Tawfik (Author), Ahmed M. Tawfik (Author), Ahmad S. Hasan (Author), Rania Elhelaly (Author), Niveen El-Wakeel (Author), Waleed Eldars (Author)
• Format: Book
• Published: Frontiers Media S.A., 2020-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Background and PurposePredictors of response to type-1 hepatorenal syndrome (HRS) therapy are urgently needed. This study's purpose is to evaluate the proposed predictors in these patients.MethodsForty-two type-1 HRS patients with cirrhosis were treated with albumin and terlipressin. Clinical, biochemical, and demographic parameters taken at the onset of therapy and changes in endothelin-1/nitric oxide (ET-1/NO) ratio during therapy were analyzed to check their predictive value.ResultsResponse to treatment (serum creatinine level <1.5 mg/dL at the end of therapy) was shown in 20 patients (48%). Independent predictive variables of response to therapy were early reduction of ET-1/NO ratio ≥0.15 at day 3 of therapy and serum bilirubin baseline <8 mg/dL (area under the receiver operating characteristic curve, 0.751; P < 0.001; specificity, 55%; sensitivity, 85%). Response rates in patients with serum bilirubin level <8 and ≥8 mg/dL were 63% and 20%, respectively (P = 0.008). The corresponding values in patients with an early reduction of ET-1/NO ratio ≥0.15 and <0.15 on day 3 were 85% and 13.6%, respectively (P < 0.001).ConclusionsEarly reduction of ET-1/NO ratio and lower serum bilirubin baseline can predict response to type-1 HRS therapy with albumin and terlipressin. Alternative therapy should be investigated for nonresponder type-1 HRS patients.

Item Description

1663-9812
10.3389/fphar.2020.00009