Meta-analysis of terlipressin in treatment of hepatorenal syndrome: an update

OBJECTIVE: To evaluate the efficacy, adverse effect and safety of terlipressin in the treatment of hepatorenal syndrome (HRS). METHODS: Correlated randomized controlled clinical trials (RCTs) comparing terlipressin with other therapies in the treatment of HRS were searched in Medline, Embase, Cochrane Library, VIP and National Knowledge Infrastructure (CNKI). Stata 9.0 was used for meta-analysis. RESULTS: 7 RCTs including 305 cases were selected for analysis in accordance with the enrollment criteria. HRS reversal rate of terlipressin was superior to that of placebo (total OR = 6.76, 95% CI = 3.37-13.56, P = 0.000); Myocardial infarction rate (total OR = 1.37, 95% CI = 0.26-7.31, P = 0.715), arrhythmic rate (total OR = 3.25, 95% CI = 0.49-21.31, P = 0.222), suspected intestinal ischemic rate (total OR = 2.14, 95% CI = 0.46-10.02, P = 0.336) and peripheral ischemic rate (total OR = 1.72, 95% CI = 0.34-8.76, P = 0.516) of terlipressin were similar with those of placebo; Mortality rate of terlipressin was a little lower than that of placebo (total OR = 0.55, 95% CI = 0.31-0.98, P = 0.044). HRS reversal rate (total OR = 0.92, 95% CI = 0.32-2.67, P = 0.877), myocardial infarction rate (total OR = 0.92, 95% CI = 0.06-15.34, P = 0.952), arrhythmic rate (total OR = 0.32, 95% CI = 0.03-3.73, P = 0.364), suspected intestinal ischemic rate (total OR = 0.92, 95% CI = 0.06-15.34, P = 0.952), peripheral ischemic rate (total OR = 0.92, 95% CI = 0.06-15.34, P = 0.952) and mortality rate (total OR = 0.80, 95% CI = 0.29-2.24, P = 0.673) of terlipressin were similar to those of noradrenalin. CONCLUSION: Terlipressin and noradrenalin are effective and safe in the treatment of HRS, the relationship between terlipressin and HRS mortality rate should be elucidated with further studies.