Multisystem hemodynamic effects of terlipressin in cirrhosis: A scoping review.

Peter Oro, Aanchal Kapoor, Christina C Lindenmeyer, Mary Pat Harnegie, Jeremy Skvarce, Albert Bui, Saloni Sachar, Matthew T Siuba

Journal: Journal of critical care 2025;87():155038

PMID: 39955856

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Abstract

INTRODUCTION

Hepatorenal syndrome (HRS-AKI) is a serious complication of advanced liver disease. Pharmacologic options are limited in effectiveness, therefore liver transplantation is the definitive therapy. Early investigation into terlipressin as a first-line therapy for HRS-AKI has been promising but expected hemodynamic changes across organ systems in patients with cirrhosis have not been thoroughly examined.

METHODS

We conducted a scoping review of the literature including adult patients with cirrhosis who received terlipressin and hemodynamic parameters were recorded. Non-human studies, case reports, conference abstracts, and review articles were excluded. Searches were performed up to December 2024 in the following databases: MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, and CINAHL.

RESULTS

Of 2022 studies retrieved, 56 studies met inclusion criteria. Heart rate, mean arterial pressure, and cardiac output were the most reported parameters. Pulmonary arterial pressure and wedge pressure were the next most common. Systemic vascular resistance, hepatic and renal measures such as resistive indices and portal pressure gradients had fewer studies. Studies reported decreased heart rate, increased mean arterial pressure, decreased cardiac output/index, and increased systemic vascular resistance. Other hemodynamic outcomes were more varied across studies.

CONCLUSIONS

Terlipressin exerts a variety of hemodynamic effects across organ systems and vascular beds. More studies are required to understand if any hemodynamic parameters might predict terlipressin response or adverse events.

Address: Department of Internal Medicine, Community Care Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.; Department of Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.; Department of Internal Medicine, Community Care Institute, Cleveland Clinic South Pointe, Cleveland, OH, USA.; Cleveland Clinic Floyd D. Loop Alumni Library, Cleveland, OH, USA.; Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.; Department of Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Electronic address: [email protected].

DOI: 10.1016/j.jcrc.2025.155038