Abstract | BACKGROUND: METHODS: RESULTS: Nineteen clinical studies with 574 total patients were included, comprising 8 randomized controlled trials, 8 prospective studies and 3 retrospective studies. The pooled percentage of patients achieving hepatorenal syndrome reversal was 49.5% (95% confidence interval, 40.0-59.1%). Increments of 100 g in cumulative albumin dose were accompanied by significantly increased survival (hazard ratio, 1.15; 95% confidence interval, 1.02-1.31; p = 0.023). A non-significant increase of similar magnitude in hepatorenal syndrome reversal was also observed (odds ratio, 1.15; 95% confidence interval, 0.97-1.37; p = 0.10). Expected survival rates at 30 days among patients receiving cumulative albumin doses of 200, 400 and 600 g were 43.2% (95% confidence interval, 36.4-51.3%), 51.4% (95% confidence interval, 46.3-57.1%) and 59.0% (95% confidence interval, 51.9-67.2), respectively. Neither survival nor hepatorenal syndrome reversal was significantly affected by vasoconstrictor dose or type, treatment duration, age, baseline serum creatinine, bilirubin or albumin, baseline mean arterial pressure, or study design, size or time period. CONCLUSIONS: This meta-analysis suggests a dose-response relationship between infused albumin and survival in patients with type 1 hepatorenal syndrome. The meta-analysis provides the best current evidence on the potential role of albumin dose selection in improving outcomes of treatment for type 1 HRS and furnishes guidance for the design of future dose-ranging studies.
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Authors | Francesco Salerno, Roberta J Navickis, Mahlon M Wilkes |
Journal | BMC gastroenterology
(BMC Gastroenterol)
Vol. 15
Pg. 167
(Nov 25 2015)
ISSN: 1471-230X [Electronic] England |
PMID | 26606982
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
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Chemical References |
- Albumins
- Vasoconstrictor Agents
- Creatinine
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Topics |
- Albumins
(administration & dosage)
- Creatinine
(blood)
- Dose-Response Relationship, Drug
- Drug Therapy, Combination
- Hepatorenal Syndrome
(blood, drug therapy, mortality)
- Humans
- Survival Analysis
- Treatment Outcome
- Vasoconstrictor Agents
(administration & dosage)
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