{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T09:20:04Z","timestamp":1778404804287,"version":"3.51.4"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2016,10,20]],"date-time":"2016-10-20T00:00:00Z","timestamp":1476921600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>The choice of vasopressor for treating cirrhosis with septic shock is unclear. While noradrenaline in general is the preferred vasopressor, terlipressin improves microcirculation in addition to vasopressor action in non\u2010cirrhotics. We compared the efficacy and safety of noradrenaline and terlipressin in cirrhotics with septic shock.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>Cirrhotics with septic shock underwent open label randomization to receive either terlipressin (n=42) or noradrenaline (n=42) infusion at a titrated dose. The primary outcome was mean arterial pressure (<jats:styled-content style=\"fixed-case\">MAP<\/jats:styled-content>) &gt;65\u00a0mm Hg at 48\u00a0h.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline characteristics were comparable between the terlipressin and noradrenaline groups.<jats:styled-content style=\"fixed-case\">SBP<\/jats:styled-content> and pneumonia were major sources of sepsis. A higher proportion of patients on terlipressin were able to achieve <jats:styled-content style=\"fixed-case\">MAP<\/jats:styled-content> &gt;65\u00a0mm of Hg (92.9% vs 69.1% <jats:italic>P<\/jats:italic>=.005) at 48\u00a0h. Subsequent discontinuation of vasopressor after hemodynamic stability was better with terlipressin (33.3% vs 11.9%, <jats:italic>P<\/jats:italic>&lt;.05). Terlipressin compared to noradrenaline prevented variceal bleed (0% vs 9.5%, <jats:italic>P<\/jats:italic>=.01) and improved survival at 48\u00a0h (95.2% vs 71.4%, <jats:italic>P<\/jats:italic>=.003). Percentage lactate clearance (<jats:styled-content style=\"fixed-case\">LC<\/jats:styled-content>) is an independent predictor of survival [<jats:italic>P<\/jats:italic>=.0001, <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>=3.9 (95% CI: 1.85\u20108.22)] after achieving the target <jats:styled-content style=\"fixed-case\">MAP<\/jats:styled-content>.Therapy related adverse effect were comparable in both the arms (40.5% vs 21.4%, <jats:italic>P<\/jats:italic>=.06), mostly minor (Grade<jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>\u201088%) and reversible.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Terlipressin is as effective as noradrenaline as a vasopressor in cirrhotics with septic shock and can serve as a useful drug. Terlipressin additionally provides early survival benefit and reduces the risk of variceal bleed. Lactate clearance is a better predictor of outcome even after achieving target <jats:styled-content style=\"fixed-case\">MAP<\/jats:styled-content>, suggesting the role of microcirculation in septic shock.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.13252","type":"journal-article","created":{"date-parts":[[2016,9,16]],"date-time":"2016-09-16T09:29:57Z","timestamp":1474018197000},"page":"552-561","source":"Crossref","is-referenced-by-count":83,"title":["A randomized trial comparing terlipressin and noradrenaline in patients with cirrhosis and septic shock"],"prefix":"10.1111","volume":"37","author":[{"given":"Ashok","family":"Choudhury","sequence":"first","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chandan K.","family":"Kedarisetty","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chitranshu","family":"Vashishtha","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Saini","sequence":"additional","affiliation":[{"name":"Department of Critical care Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sachin","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Pulmonology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakhi","family":"Maiwall","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoj K.","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajeet S.","family":"Bhadoria","sequence":"additional","affiliation":[{"name":"Department of Research Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guresh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Research Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yogendra K.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiv K.","family":"Sarin","sequence":"additional","affiliation":[{"name":"Department of Hepatology Institute of Liver and Biliary Sciences New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,10,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra043632"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.06.019"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23264"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3350\/kjhep.2010.16.4.347"},{"key":"e_1_2_8_6_1","first-page":"139","article-title":"Mechanisms of vascular hyporesponsiveness in septic shock","volume":"2","author":"Kimmoun A","year":"2013","journal-title":"Curr Vasc Pharmacol"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.5.1122"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc11469"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc7990"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-008-0118-7"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067373"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199206000-00025"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31827e83af"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.158"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000000466"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc5195"},{"key":"e_1_2_8_17_1","unstructured":"Common Terminology Criteria for Adverse Events v3.0 (CTCAE).Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events Version 3.0 DCTD NCI NIH DHHS.http:\/\/ctep.cancer.gov. 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