Pharmacotherapy for Liver Cirrhosis and Its Complications by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9789811926150
Publisher: Springer Nature Singapore

7.5 The Evidences of HSA in Liver Cirrhosis and its Complications

7.5.1 HSA and HRS

HRS is the result of a worsened circulatory dysfunction in liver cirrhosis. The splanchnic arterial vasodilatation and the development of cirrhotic cardiomyopathy in liver cirrhosis result in severe underfilling perfusion of the organs, including kidney, thereby leading to renal failure [30, 31]. Systematic inflammation is associated with the development of complications in liver cirrhosis [6], including HRS [32]. Additionally, systemic inflammation is also significantly associated the prognosis of liver cirrhosis [33]. HSA has been recommended as the first-line options of the management of HRS in current guidelines [7, 34, 35]. The mechanism may be that HSA could improve HRS by improving the circulatory dysfunction and the systematic inflammation. Furthermore, a large number of RCTs explored the effect of HSA plus vasoactive drugs on the management of HRS, and the results showed that HSA plus vasoactive drugs could significantly improve the renal function and increase the rate of HRS reversal than HSA alone, but not significant in the survival of type-1 HRS [36–38]. A meta-analysis, which included 25 RCTs and involved 1263 participants, suggested that HSA plus noradrenaline had fewer adverse events than HSA plus terlipressin, and HSA plus midodrine or plus octreotide or HSA alone had lower rate of HRS reversal than HSA plus terlipressin [39].

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