Effect of terlipressin on renal outcomes in patients with liver cirrhosis and ascites: a retrospective multicenter study

BACKGROUND: Terlipressin is recommended for the treatment of acute kidney injury (AKI) in cirrhotic patients, but its role in those with ascites but without AKI is unclear. METHODS: We retrospectively enrolled 905 cirrhotic patients with ascites from three hospitals, of whom 250 received terlipressin and 655 standard medical therapy. Patients were stratified by baseline serum creatinine (Scr) into stable renal function (Scr < 133 μmol/L; n = 784) and renal dysfunction (Scr ≥ 133 μmol/L; n = 121) cohorts. Primary outcomes included AKI, renal dysfunction, and renal function improvement. Propensity score matching (PSM) was performed. Multivariable logistic regression was further performed in the stable renal function cohort to assess the independent association between terlipressin and AKI. Odds ratio (OR) was calculated. RESULTS: In the stable renal function cohort, after PSM (n = 120), terlipressin group had lower incidence of AKI (1.67% vs. 16.67%, p = 0.001) and renal dysfunction (0% vs. 8.33%, p = 0.068); and multivariate logistic regression analysis confirmed that terlipressin was independently associated with lower incidence of AKI (OR =0.093, p = 0.027). In the renal dysfunction cohort, after PSM (n = 34), terlipressin was associated with higher incidence of renal function improvement (70.59% vs. 23.53%, p = 0.006). CONCLUSION: Terlipressin may be associated with favorable renal outcomes in cirrhotic patients with ascites, regardless of baseline renal function.