74; 95% CI = 0.40–1.39), 60 days (RR, 0.71; 95% CI, 0.31–1.48), 90 days (RR, 0.89; 95% CI, 0.66–1.22),

or 180 days (RR, 0.83; 95% CI, 0.65–1.05). As described above, only trials on terlipressin plus albumin versus albumin reported reversal of HRS. In these trials, 46 patients randomized to terlipressin plus albumin survived, whereas 54 had reversal of HRS. These data suggest that some patients died in spite of the improved renal function. Accordingly, a clinically relevant outcome measure would be survival with reversal of HRS. We attempted to perform a post hoc analysis combining these two outcome measures, but were only able to extract the necessary data from one trial.19 The trial found a beneficial effect of terlipressin plus albumin on the composite outcome check details measure of survival plus reversal of HRS (RR, 0.76; 95% CI, 0.61–0.93). Both trials

on noradrenalin plus albumin versus terlipressin plus albumin reported mortality and improved renal function.28, 30 One trial reported reversal of HRS.30 The trials found no difference between treatments on mortality (12/30 versus 13/32; RR, 0.98; 95% CI, 0.54–1.78; I2, 0%), reversal of HRS (10/20 versus 8/20; RR, 1.25; 95% CI, 0.63–2.5) or improvement in renal function (18/30 versus 21/32; RR, 0.90; 95% CI, 0.63–1.30; I2, 0%). The trial comparing bolus versus continuous administration of terlipressin plus albumin29 found no differences in mortality (10/18 versus 11/19 patients; RR, 0.96; 95% CI, 0.55–1.69) or reversal of HRS (9/18 versus 14/19 patients; RR, 0.96; 95% CI, 0.55–1.69). Remaining Mirabegron outcome measures were not reported. The present review suggests that vasoconstrictor click here drugs alone or with

albumin prolong short-term survival in type 1 HRS. Our subgroup analyses identified an effect on mortality at 15 days, but not at 30 days or beyond. The duration of the response should be considered when making treatment decisions and in the timing of liver transplantations. The improved survival seems related to an increased number of patients with reversal of HRS. On the other hand, the treatment also increases the risk of cardiovascular adverse events, including potentially serious events (such as myocardial infarction). Assessment of potential contraindications and close monitoring of adverse events seems essential. The present review identified several methodological concerns in some trials, including unclear randomization and lack of sample size calculations and blinding. The number of patients included with type 2 HRS and the number of patients in trials on terlipressin alone or octreotide plus albumin was too small to make treatment recommendations. Likewise, few patients were included in the trials comparing noradrenalin plus albumin versus terlipressin plus albumin or the trial comparing terlipressin administered as bolus or continuous infusion. None of these trials was designed to establish equivalence.