A Meta-analysis Of Efficacy And Safty Of Vasoconstrictors In Treatment Of Patients With Hepatorenal Syndrome

Objective: To evaluate the efficacy and safety of vasoconstrictors which containsterlipressin, ornipressin, midodrine, octreotide, dopamine, or norepinephrine in thetreatment of hepatic cirrhosis’ complication hepatorenal syndrome (HRS). We used Metaanalysis to assess the evidence．based medicine results．Methods:Randomized controlledtrials (RCTs) about the effect of vasoconstrictors on patients with HRS from January1989to December2011were searched for according to inclusion and exclusion criteria.Eleven studies were chosen at last for Meta-analysis. The data were analysed byREVMAN5.0software.Results: The meta analysis showed: First, After therapy,vasoconstrictor was superior to non-vasoconstrictor in improvement of survival rate andHRS reversal (P＜0.05); Terlipressin is not inferior to the commonly usednorepinephrine in improvement of survival rate (P＞0.05). Second, The clinical’sefficacy were assessed with the weighted mean difference of urine output, mean arterialblood pressure and creatinine were superior to the non-vasoconstrictor (P＜0.05),terlipressin was not superior to norepinephrine (P＞0.05). Finally the results ofmeta-analyses showed that compared with the control group about the incidence ofadverse response: vasoconstrictor was more than control group (P＜0.05), but terlipressinand norepinephrine effects were no significant differences (P＞0.05).Conclusion:Vasoconstrictors,such as terlipressin and norepinephrine, can reduce the HRS patientsmortality and improve renal function, increased urine output and lower serum creatinine,increase mean arterial blood pressure; Norepinephrine and terlipressin treatment ofhepatorenal syndrome in three RCT analysis showed that to norepinephrine treatment ofhepatorenal syndrome with terlipressin efficacy similar, but the cost of treatment was significantly less than terlipressin, but because small sample size, and still more RCTconfirmed.