5 mg/dL) during treatment or a reduction in serum creatinine of greater than 50% of the pretreatment value but with an end-of-treatment value equal to or greater than 133 μmol/L (1.5 mg/dL). The probability of response was calculated using the Kaplan–Meier method. Patients treated with liver transplantation (n = 4) were included in the calculation of overall response and were considered censored at the time of transplantation. Comparisons of variables between patients were made using the Student t test for continuous data and the χ2 test for categorical data. Comparisons of variables
obtained at different time points were performed using a paired Student t test and Wilcoxon Ponatinib test. A multivariate analysis including variables with predictive value in the univariate analysis (P < 0.10) was performed using stepwise logistic regression. The best cutoff values for parameters with independent predictive value were calculated using receiver operating characteristic curves (AUC). Statistical analysis was performed using SPSS version 14 for Windows (SPSS Inc., Chicago, IL). Results are expressed as the mean ± standard
deviation. P < 0.05 was considered statistically significant. The baseline characteristics of patients with cirrhosis and type 1 HRS before the initiation of therapy with terlipressin and albumin are shown in Table 1. As expected, most patients had severe liver failure, as indicated by high serum bilirubin Enzalutamide purchase and prothrombin time and high Child-Pugh and Model for End-Stage Liver Disease (MELD) scores, and severe renal failure with high serum creatinine levels and low glomerular filtration rate, estimated using Modification of Diet in Renal Disease equation.20 Finally, patients showed marked circulatory dysfunction with low mean arterial pressure (MAP) and marked activation of vasoactive systems.
Eighteen out of 39 patients (46%) had response to treatment. In 16 of the 18 patients, serum creatinine decreased below 1.5 mg/dL at the end of therapy, whereas in the other two patients serum creatinine decreased by more than 50% compared selleckchem with pretreatment values but did not end up below 1.5 mg/dL (from 4.7 and 3.5 mg/dL to 1.7 and 1.6 mg/dL, respectively). The remaining 21 patients did not meet the criteria of response to treatment. Values of serum creatinine throughout treatment in responders and nonresponders are shown in Fig. 1. The probability of response during treatment in the entire series of patients is shown in Fig. 2. Median time to response was 14 days. In most patients, response to treatment was persistent. HRS recurred in five of the 18 patients who responded to treatment (mean time to recurrence, 14 days [range, 2–46 days]). Response to treatment was associated with an improvement in circulatory function, as indicated by an increase in arterial pressure at the end of treatment period and marked suppression in the activity of the renin-angiotensin-aldosterone system and sympathetic nervous system (Table 2).