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2015 ; 10
(8
): e0135625
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Creatinine Change on Vasoconstrictors as Mortality Surrogate in Hepatorenal
Syndrome: Systematic Review & Meta-Analysis
#MMPMID26295585
Belcher JM
; Coca SG
; Parikh CR
PLoS One
2015[]; 10
(8
): e0135625
PMID26295585
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BACKGROUND AND AIMS: Hepatorenal syndrome is a severe complication of cirrhosis
and associates with significant mortality. Vasoconstrictor medications improve
renal function in patients with hepatorenal syndrome. However, it is unclear to
what extent changes in serum creatinine during treatment may act as a surrogate
for changes in mortality. We have performed a meta-analysis of randomized trials
of vasoconstrictors assessing the association between changes in serum
creatinine, taken as a continuous variable, and mortality, both while on
treatment and during the follow-up period for survivors. METHODS: The electronic
databases of PubMed, Web of Science and Embase were searched for randomized
trials evaluating the efficacy of vasoconstrictor therapy for treatment of HRS
type 1 or 2. The relative risk (RR) for mortality was calculated against delta
creatinine. The proportion of treatment effect explained (PTE) was calculated for
delta creatinine. RESULTS: Seven trials enrolling 345 patients were included. The
correlation between delta creatinine and ln (RR) was moderately good (R2 = 0.61).
The intercept and parameter estimate indicated a fall in creatinine while on
treatment of 1 mg/dL resulted in a 27% reduction in RR for mortality compared to
the control arm. In patients surviving the treatment period, a fall in creatinine
while on treatment of 1 mg/dL resulted in a 16% reduction in RR for
post-treatment mortality during follow-up. The PTE of delta creatinine for
overall mortality was 0.91 and 0.26 for post-treatment mortality. CONCLUSIONS:
Changes in serum creatinine in response to vasoconstrictor therapy appear to be a
valid surrogate for mortality, even in the period following the completion of
treatment.
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