Predictors of tolvaptan short-term response in patients with refractory ascites: A meta-analysis.

ABSTRACT

BACKGROUND AND AIM: Tolvaptan represents an oral V2 -receptor antagonist, which has been suggested as a promising add-on diuretic treatment for refractory ascites. The present meta-analysis aims to accumulate current evidence and identify which clinical and laboratory factors are linked to short-term response to tolvaptan therapy. METHODS: Medline, Scopus, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and Google Scholar databases were searched from inception. All observational studies reporting the correlation of patients' characteristics with tolvaptan response were selected. RESULTS: Tolvaptan response was associated with significantly higher baseline body weight (mean difference 4.59 kg, 95% confidence interval [CI] [3.58, 5.61]), presence of hepatitis C (odds ratio 1.59 95% CI [1.18, 2.14]), lower blood urea nitrogen (BUN) (mean difference -6.88 mg/dL, 95% CI [-8.13, -5.63]), lower serum creatinine (mean difference -0.17 mg/dL, 95% CI [-0.30, -0.05]), lower C-reactive protein (mean difference -1.43 mg/dL, 95% CI [-2.52, -0.35]), and higher sodium levels (mean difference 1.00 mEq/L, 95% CI [0.45, 1.55]). The outcomes of bodyweight, hepatitis C, BUN, and C-reactive protein remain significant independently of response definition and risk of bias. CONCLUSIONS: The present findings suggest bodyweight, BUN, C-reactive protein, and hepatitis C as potential predictive factors of tolvaptan short-term response in patients with refractory ascites. Future studies are needed to introduce cut-off values and construct an optimal combined screening model.