COMPARISON OF EFFICACY ON NORADRENALINE AND TERLIPRESSIN IN HEPATORENAL SYNDROME IN THE PATIENTS OF DECOMPENSATED CIRRHOSIS – A RANDOMIZED CONTROLLED STUDY
Objective: To compare the efficacy of noradrenaline and terlipressin in hepatorenal syndrome.
Study Design: Randomized controlled trial.
Place and Duration of Study: Combined Military Hospital Lahore, from May 2018 to Jan 2019.
Material and Methods: A randomized controlled trial was carried out at CMH Lahore. Patients admitted in hospital with diagnosis of hepatorenal syndrome were included in the study by non-probability convenient sampling. Detailed history and examination was carried out. PT/INR, Serum bilirubin, albumin, creatinine, sodium and urine output (ml/24 hour), were measured in all patients. Patient were screened by applying inclusion and exclusion criteria and randomized into terlipressin group and noradrenaline group and treated for one week as per study protocol. Serum creatinine level <133 μmol/L was considered reversal of hepatorenal syndrome. Data was collected on a predesigned form and entered in SPSS software for data analysis. Proportions were compared by applying chi square test and independent sample t test was applied for comparing means. For statistical significance p-value ≤0.05 was the standard.
Results: The study comprised of 40 patients. Both terlipressin and noradrenaline groups had 20 patients each. In terlipressin group 9 (45%) patients and in noradrenaline group 8 (40%) patients achieved the reversal of hepatorenal syndrome, respectively (p-value 0.5). Only 2 (10%) patient died in each group (p-value 0.698). Mortality was 2 (10%) in noradrenaline group and 2 (10%) in terlipressin group (p-value 0.698).
Conclusion: Terlipressin and noradrenaline are both effective and benign noninvasive treatment options for hepatorenal syndrome in the circumstances where liver transplant is not available. Noradrenaline and terlipressin have similar efficacy and safety profile.