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Digestive Diseases and Sciences

, Volume 60, Issue 5, pp 1474–1481 | Cite as

A Treat-to-Target Concept to Guide the Medical Management of Hepatorenal Syndrome

  • Cindy X. Cai
  • Geetha Maddukuri
  • Navin Jaipaul
  • Zhiwei Zhang
Original Article

Abstract

Background

The principle of treating-to-target has been successfully applied to many diseases with significant improvement in patient care and as a useful guidance for healthcare providers. Appreciation of the central role for arterial vasodilatation in the pathogenesis of hepatorenal syndrome (HRS) has led to routine use of vasoconstrictors in combination with albumin in patients with HRS. An appropriate target to guide such therapy, however, has not yet been established.

Aims

The purpose of the current study was to identify a suitable target that can predict clinical outcome and guide the medical management of type 1 HRS, a condition associated with very poor prognosis.

Methods

A total of 85 patients with type 1 HRS who received a combination therapy of vasoconstrictors and albumin were enrolled. A potential therapeutic target was identified by univariate and multivariate logistic regression analyses. The treat-to-target concept to guide the management of HRS was then tested via a retrospective cohort study.

Results

A change in mean arterial pressure (MAP) during treatment was identified as a sole independent predictor for patient survival. Compared with mild or no increase in MAP, achievement in a marked increase in MAP of more than 10 mmHg in these patients was associated with better overall survival and transplant-free survival. Increased MAP to higher than 15 mmHg did not result in further improvement in clinical outcome.

Conclusions

A treat-to-target concept by the use of a specific goal of MAP is feasible and may potentially guide the medical management of type 1 HRS.

Keywords

Treat-to-target Hepatorenal syndrome Mean arterial pressure Vasoconstrictor 

Notes

Acknowledgments

Geetha Maddukuri was supported by an educational fund from the US Department of Veteran Affairs. We are grateful to the Saint Louis University’s hepatology team, including Drs. Alex Befeler, Brent Neuschwander-Tetri, Lliana Bouneva, Adrian Di Bisceglie, and Bruce Bacon, for their support during the study period.

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York (Outside the USA) 2014

Authors and Affiliations

  • Cindy X. Cai
    • 1
  • Geetha Maddukuri
    • 2
  • Navin Jaipaul
    • 3
  • Zhiwei Zhang
    • 3
  1. 1.Division of Gastroenterology, Department of MedicineVA Loma Linda Healthcare System and Loma Linda UniversityLoma LindaUSA
  2. 2.Division of Nephrology, Department of MedicineVA St. Louis Healthcare System and St. Louis UniversitySt. LouisUSA
  3. 3.Division of Nephrology, Department of MedicineVA Loma Linda Healthcare System and Loma Linda UniversityLoma LindaUSA

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