{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T02:36:43Z","timestamp":1785551803981,"version":"3.56.0"},"reference-count":22,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T00:00:00Z","timestamp":1600646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hepatology Research"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>To optimize the therapeutic strategy for patients with decompensated cirrhosis manifesting hepatic ascites and\/or edema, factors affecting the outcome of patients receiving tolvaptan were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The subjects were 165 patients receiving tolvaptan including 116 patients (70%) also treated with furosemide. The therapeutic efficacy of tolvaptan was defined as \u201ceffective\u201d when a body weight reduction of 1.5\u00a0kg or more was obtained within 1\u00a0week. The long\u2010term outcome was defined as \u201cfavorable\u201d when the ascites\u2010related events\u2010free duration was prolonged following tolvaptan treatment, compared with that before treatment, or ascites\u2010related events were absent for at least 120\u00a0days during treatment based on the hazard function analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Tolvaptan was effective in 115 patients (70%). Among them, the long\u2010term outcome was evaluated in 99 patients and was favorable in 70 patients (71%). A multivariate analysis revealed that the serum blood urea nitrogen levels at baseline (odds ratio 0.960 per +1\u00a0mg\/dL, <jats:italic>P<\/jats:italic>\u2009=\u20090.021) and the type of tolvaptan initiation (planned vs. emergent; 3.695, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) were associated with therapeutic efficacy, while the furosemide dose (0.280 per +20\u00a0mg\/day, <jats:italic>P<\/jats:italic>\u2009=\u20090.014) and previous ascites\u2010related events (0.074, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) were associated with the long\u2010term outcome. Receiver operating curve analyses identified the optimal cut\u2010off values for the furosemide dose as 15\u00a0mg\/day (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Furthermore, the cumulative survival rates in patients receiving furosemide at 15\u00a0mg\/day or less were significantly higher than those in the remaining patients (<jats:italic>P<\/jats:italic>\u2009=\u20090.048).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Furosemide given at baseline contributed to an unfavorable outcome in patients receiving tolvaptan; consequently, tolvaptan should be given before increasing the furosemide dose.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hepr.13566","type":"journal-article","created":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T22:23:26Z","timestamp":1599258206000},"page":"1355-1364","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Furosemide as a factor to deteriorate therapeutic efficacy of tolvaptan in patients with decompensated cirrhosis"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6012-0915","authenticated-orcid":false,"given":"Yoshihito","family":"Uchida","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mie","family":"Inao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shohei","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayato","family":"Uemura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun\u2010ichi","family":"Kouyama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayoko","family":"Naiki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine Saitama Medical University  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayoko","family":"Sugawara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Faculty of Medicine Saitama Medical University  Saitama 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