特利加压素
交叉研究
医学
腹水
随机对照试验
内科学
病理
肝肾综合征
替代医学
安慰剂
作者
Ryma Terbah,Adam Testro,Rudolf Hoermann,Avik Majumdar,Brooke Chapman,Paul Gow,Marie Sinclair
标识
DOI:10.1097/hep.0000000000000820
摘要
Background and Aims: Observational studies suggest a beneficial effect of continuous terlipressin infusion (CTI) on ascites and sarcopenia in decompensated cirrhosis with portal hypertension. Approach and Results: This single-center, prospective, cross-over study randomized 30 patients with cirrhosis, ascites, and sarcopenia to commence on 12 weeks of home CTI or 12 weeks of observation prior to cross-over. The co-primary outcomes were change in handgrip strength and paracentesis volume. Secondary outcomes included quality of life, sarcopenia measures, renal function, safety, and hospitalization. The median age of participants was 62 years (IQR: 57–64), the median Model for End-Stage Liver Disease-Sodium was 16 (12.3–20.8), and 22 (73%) were male. Handgrip strength increased by a mean adjusted difference (MAD) of 3.09 kg (95% CI: 1.11–5.08 kg) between CTI and observation ( p =0.006); an 11.8% increase from baseline. The total volume of ascites drained decreased by a MAD of 11.39L (2.99–19.85, p =0.01), with 1.75 fewer episodes of paracentesis (0.925–2.59, p <0.001) on CTI. Serum creatinine decreased, urinary sodium excretion increased, and quality of life was significantly higher on CTI (all p <0.001), with an increase in Chronic Liver Disease Questionnaire score of 0.41 points (0.23–0.59). There were 7 minor line-related complications but no cardiac events or pulmonary edema. Conclusions: This novel study demonstrates a significant increase in handgrip strength, reduction in paracentesis volume, and improved quality of life in patients with decompensated cirrhosis treated with continuous terlipressin infusion. These findings provide a strong rationale for the use of ambulatory CTI in appropriately selected patients with cirrhosis.
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