{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T11:13:44Z","timestamp":1794482024489,"version":"4.9.1"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T00:00:00Z","timestamp":1550620800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T00:00:00Z","timestamp":1550620800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:p>\n                    Hepatorenal syndrome (HRS) carries a high short\u2010term mortality in patients with cirrhosis and acute on chronic liver failure (ACLF). Terlipressin and noradrenaline are routinely used in cirrhosis with HRS and have been found to be equally effective. There are no data comparing the efficacy of terlipressin with noradrenaline in ACLF patients with HRS. In an open\u2010label, randomized controlled trial (RCT), consecutive patients with ACLF diagnosed with HRS acute kidney injury (AKI) were randomized to albumin with infusion of terlipressin (2\u201012 mg\/day; n = 60) or noradrenaline (0.5\u20103.0 mg\/h; n = 60). Response to treatment, course of AKI, and outcome were studied. Baseline characteristics, including AKI stage and sepsis\u2010related HRS\u2010AKI, were comparable between groups. Compared to noradrenaline, terlipressin achieved greater day 4 (26.1% vs. 11.7%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.03) and day 7 (41.7% vs. 20%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.01) response. Reversal of HRS was also better with terlipressin (40% vs. 16.7%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.004), with a significant reduction in the requirement of renal replacement therapy (RRT; 56.6% vs. 80%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.006) and improved 28\u2010day survival (48.3% vs. 20%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.001). Adverse events limiting use of drugs were higher with terlipressin than noradrenaline (23.3% vs. 8.3%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.02), but were reversible. On multivariate analysis, high Model for End\u2010Stage Liver Disease (MELD; odds ratio [OR], 1.10; confidence interval [CI] = 1.009\u20101.20;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.03) and noradrenaline compared to terlipressin (OR, 3.05; CI = 1.27\u20107.33;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.01) predicted nonresponse to therapy. Use of noradrenaline compared to terlipressin was also predictive of higher mortality (hazard ratio [HR], 2.08; CI = 1.32\u20103.30;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.002).\n                    <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic>\n                    AKI in ACLF carries a high mortality. Infusion of terlipressin gives earlier and higher response than noradrenaline, with improved survival in ACLF patients with HRS\u2010AKI.\n                  <\/jats:p>","DOI":"10.1002\/hep.30208","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T02:28:47Z","timestamp":1533608927000},"page":"600-610","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":175,"title":["Terlipressin Is Superior to Noradrenaline in the Management of Acute Kidney Injury in Acute on Chronic Liver Failure"],"prefix":"10.1097","volume":"71","author":[{"given":"Vinod","family":"Arora","sequence":"first","affiliation":[{"name":"Department of Hepatology, Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakhi","family":"Maiwall","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayaraghavan","family":"Rajan","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankur","family":"Jindal","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saggere","family":"Muralikrishna Shasthry","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guresh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Clinical Research and Biostatistics, Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Clinical Research and Biostatistics, Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiv Kumar","family":"Sarin","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,2,20]]},"reference":[{"key":"hep30208-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"CANONIC Study Investigators of the EASL\u2013CLIF Consortium. 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