Norepinephrine useful rescue therapy in hepatorenal syndrome in non ICU setting: Study

The results of the study are as follows:

A total of 61 patients were administered midodrine and octreotide for the treatment of HRS, with a 28% response rate.

The median MELD-Na (Model for End-Stage Liver Disease–sodium) the score was 30.

Responders were more likely to have alcohol-related liver disease and lower Acute-on-Chronic Liver Failure (ACLF) grade.

Of the non-responders, 20 were then administered norepinephrine, of whom 45% achieved full or partial response.

Achieving a MAP increase of ≥10 mm Hg was associated with a greater probability of response.

Patients who responded to norepinephrine experienced improved transplant-free survival at 90 days; 5 of 20 patients experienced norepinephrine treatment-related adverse events, namely arrhythmias.

Thus, the researchers concluded that norepinephrine can be effectively used in a non-ICU setting as rescue therapy in patients who have not responded to midodrine and octreotide. Based on these data, we propose a practical stepwise algorithm for vasoconstrictor therapy to manage HRS in situations where terlipressin is not an option.

Reference:

Feasibility and Effectiveness of Norepinephrine Outside the Intensive Care Setting for Treatment of Hepatorenal Syndrome by Kwong A et. al. published in the AASLD.

https://doi.org/10.1002/lt.26065