Terlipressin for the treatment of hepatorenal syndrome: a meta-analysis of randomized controlled trials

Objective This study aimed to evaluate the efficacy and safety of terlipressin and albumin in patients with hepatorenal syndrome. Methods A systematic review with meta-analysis of randomized controlled trials comparing terlipressin and albumin versus albumin with or without placebo in patients with cirrhosis and hepatorenal syndrome was performed. The study protocol was registered at the PROSPERO platform (CRD42021246684). Results Nine randomized controlled trials fulfilled the selection criteria and were included in this meta-analysis. There was no evidence of a significant difference between the groups regarding mortality in 15 days [risk ratio (RR) = 0.73, 95% confidence interval (CI) = 0.47–1.13, P = 0.16, I 2 = 52%] or in 90 days (RR = 0.94, 95% CI = 0.80–1.09, P = 0.84, I 2 = 29%). Regarding hepatorenal syndrome reversal failure, a significant benefit was demonstrated in the terlipressin and albumin group (RR = 0.64, 95% CI = 0.53–0.78, P < 0.00001, I 2 = 72%). There was no evidence of a significant difference between the groups regarding adverse events (RR = 3.5, 95% CI = 0.94–13.09, P = 0.06, I 2 = 89%). Conclusion Terlipressin associated with albumin led to a significantly lower rate of hepatorenal syndrome reversal failure, but there was no evidence of a significant effect of this treatment regarding mortality or adverse events.