MODIFIED TREATMENT OF HEPATORENAL SYNDROME TYPE I DEPENDING ON THE STAGE OF ACUTE KIDNEY INJURY.

Hepatorenal syndrome is a severe complication of liver cirrhosis which is difficult to treat because of a very fast course and lack of adequate dosing recommendations due to the stage of the disease. In this study we aimed to refine the treatment of hepatorenal syndrome type I by modifying the dose of terlipressin, depending on the stage of acute kidney injury (AKI). Objective - to improve the treatment method of hepatorenal syndrome type I in patients with alcoholic liver cirrhosis by selecting the dose of terlipressin depending on the stage of acute kidney injury. For this study were enrolled 161 patients with diagnosis alcoholic liver cirrhosis, complicated with the hepatorenal syndrome. All patients were were randomly divided into control (group 1) (n=79) and study (group 2) (n=82) groups depending on the treatment received (terlipressin in the standard dosage or modified by the response-guided titration method). If the serum creatinine level decreased less than 25% from the baseline, the dose of terlipressin was gradually increased but did not accede 12 mg/24 hours. The stage of AKI was diagnosed using the criteria of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury, 2012. The risk of short term mortality (within the first 29 days) was prognosed by Model for End-Stage Liver Disease (MELD) score. The kidney function improved better in persons with a modified dose of terlipressin: the complete response rate in them was 81.7%. The response rate in those who received the standard treatment, was 66.7% only (p˂0.05). It was found that the effective dosage of terlipressin is 3 mg/24 for AKI stage I; 6 mg/24 - for AKI stage II; 12 mg/24 - for AKI stage III. The relapse of the disease occurred only in 23.2% patients with modified treatment against 40.1% in the control group (p˂0.05). Short term survival was also significantly higher in the study group - 54.9%, while in the control group it was 37% only (p˂0.05). Thus, correction of terlipressin dosage could improve the results of the treatment and reduce mortality in patients with hepatorenal syndrome type I.

VALIDATION OF CLIF-C-ACLF SCORE FOR ALCOHOLIC LIVER CIRRHOSIS.

The concept of acute-on-chronic liver failure (ACLF) covers acute deterioration of the liver function in patients with alcoholic cirrhosis (ALC) caused by secondary or extra-hepatic provoking factors (PF) leading to dysfunction of target organs. CLIF-C-ACLF score refers to the number of decompensated organs/systems and is recommended for predicting outcome in patients with ALC. Objective - to compare the diagnostic value of the Child-Pugh score and the CLIF-C-ACLF score for predicting short-term mortality in patients with ALC. The clinical data of 150 patients with ALC were retrospectively analyzed. Enrolled patients were divided into 2 groups according to the presence / absence of PF 3 months before the death: I group (n = 83) - without PF (CLF), group II (n= 67) - with PF (ACLF). To assess the severity of ALC we used the Child-Pugh score and the CLIF-C-ACLF score. Infectious complications were considered as PF. The sensitivity of the STMP by Child-Pugh score in group 1 was 100% (95% CI 58.9-100), specificity was 38.9% (95% CI 30.9-47.4). The sensitivity for the CLIF-C-ACLF score was 100% (95% CI 58.9-100), specificity-93.75% (95% CI 88.5-97.1).A. The sensitivity of STMP by Child-Pugh score in group II was 100% (95% CI 54.1-100), specificity was 29.5% (95% CI -42.6 to 18.5). The sensitivity of STMP by CLIF-C-ACLF in score II was 100% (95% CI 58.9-100), specificity was 88.5% (95% CI 77.8-95.2). The CLIF-C-ACLF corresponded to the model of excellent quality in groups I (0.99) and II (0.97) and was higher than the Child-Pugh score in both groups (p = 0.012 and p = 0.015 respectively). The diagnostic value of the CLIF-C-ACLF score for predicting short-term mortality in patients with ALC is higher than Child-Pugh, especially for acute decompensation of ALC caused by precipitating factors.