Treatment of Type-1 Hepatorenal Syndrome Associated With Sepsis

All consecutive patients with cirrhosis hospitalized with an infection or who developed an infection during hospitalization for an acute decompensation of the disease in four university hospitals.

Criteria for inclusion were: 1/ cirrhosis as diagnosed by liver biopsy or a combination of clinical, biochemical, ultrasonographic, and/or endoscopic findings; 2/ age between 18 and 80 years; 3/ presence of sepsis, as defined by infection and signs of Systemic Inflammatory Response Syndrome; and 4/ occurrence of type-1 HRS during the infection, as defined by standard diagnostic criteria. Exclusion criteria were: 1/ hepatocellular carcinoma outside the Milan criteria; 2/ any severe extrahepatic condition, including cardiovascular, neurological, and organic kidney diseases; 3/ septic or hypovolemic shock; 4/ terminal condition (death expected in less than 48 hours); and 5/ lack of informed consent.

Aim: A proof of concept study to evaluate whether treatment with terlipressin and albumin in the course of an infection associated with type-1 HRS is effective and safe.

Inclusion criteria

• Cirrhosis as diagnosed by liver biopsy or a combination of clinical, biochemical, ultrasonographic, and/or endoscopic findings.
• Age between 18 and 85 years.
• Presence of sepsis, as defined by active infection, and signs of Systemic Inflammatory Response Syndrome.
• Occurrence of type-1 HRS during the infection, as defined by standard diagnostic criteria.

Exclusion criteria

• Hepatocellular carcinoma outside the Milan criteria.
• Any severe extrahepatic condition, including cardiovascular, neurological, and organic kidney diseases.
• Septic or hypovolemic shock.
• Terminal condition (death expected in less than 48 hours).
• Lack of informed consent.