Evaluation of Terlipressin and In-Hospital Mortality in the Treatment of Hepatorenal Syndrome-Acute Kidney Injury (HRS-AKI)

Background: Terlipressin is a synthetic vasopressin analogue that is indicated for the treatment of hepatorenal syndrome-acute kidney injury (HRS-AKI) to improve kidney function and haemodynamics. Despite its previous approval in Europe, terlipressin was Food and Drug Administration (FDA)-approved in 2022 in the United States. Historical standards of care, such as midodrine and octreotide (MO), are still used alternatively to terlipressin, and mortality benefit among treatments is unknown. Objective: To examine the effects of terlipressin vs MO in hospitalized patients with HRS-AKI. Methods: This single-centre, retrospective, cohort study was conducted at a large, tertiary academic medical centre. Data were collected from the electronic health record for patients admitted from July 2018 to July 2024. Patients ≥18 years of age admitted with International Classification of Diseases codes for cirrhosis, AKI, and clinical diagnosis of HRS were included. The primary outcome was the incidence of in-hospital mortality between patients receiving terlipressin vs MO. Descriptive statistics and parametric and non-parametric tests were utilized as appropriate. Results: A total of 49 terlipressin patients and 30 MO patients were identified. The rate of in-hospital mortality was lower with terlipressin (n = 12, 24.5%) vs MO (n = 21, 70%) ( P < .001). The mean hospital length of stay (days) was greater with terlipressin than MO (21.4 ± 14 vs 15.5 ± 8.4, P = .081) as was baseline serum creatinine (SCr) (2.94 ± 1.1 vs 1.89 ± 1.2 mg/dL, P < .05). Numerically more patients receiving terlipressin had a response to therapy (21/49 vs 12/30, P = .1033) with a similar decrease in SCr (–34.8 ± 21% vs –36.1 ± 21%, P = .86). The number of days from therapy initiation until the lowest SCr was less with terlipressin vs MO (4.97 ± 3.5 vs 7.92 ± 3.7, P = .02). Conclusion and Relevance: Terlipressin appears to effectively improve renal function and in-hospital mortality in patients with HRS-AKI compared with MO. Terlipressin may be used as a first-line treatment for HRS-AKI or after a trial of MO based on the study’s results.