OBJECTIVES Evidence on the comparison of treatments for hepatorenal syndrome-acute kidney injury (HRS-AKI) in a US population is limited. An indirect comparison of terlipressin plus albumin versus midodrine and octreotide plus albumin (MO) may provide further insight into treatment efficacy. METHODS Cohorts of patients treated for HRS-AKI characterized by serum creatinine [SCr] < 5 mg/dL, baseline acute-on-chronic liver failure (ACLF) grades 0-2, and exclusion of patients listed for transplant if MELD ≥ 35 were pooled from 1) the CONFIRM and REVERSE randomized controlled trials (N=159 meeting eligibility criteria from N=216 overall treated with terlipressin) and 2) a retrospective review of medical records from 10 US tertiary hospitals (2016-2019; N=55 treated with MO meeting eligibility criteria from N=200 overall). The primary endpoint comparing the two cohorts was HRS reversal defined as achieving SCr ≤1.5 mg/dL at least once during the treatment. Covariate balancing propensity scoring was used to adjust for differences in baseline characteristics. RESULTS HRS-AKI reversal was achieved in 52.35% of terlipressin-treated patientscompared to 20% of MO-treated patients [adjusted mean difference (95% confidence interval)= 32.35% (17.40, 47.30), p<.0001]. Terlipressin patients had increased overall survival (adjusted HR=0.57 (0.35,0.93), p=0.02) but similar transplant-free survival (adjusted HR= 0.79 (0.53,1.17), p=0.24). Achievement of HRS-AKI reversal was associated with increased OS and TFS regardless of treatment (p <0.001). CONCLUSIONS Consistent with prior reports, terlipressin plus albumin is more effective in improving kidney function and achieving HRS-AKI reversal than MO plus albumin based on indirect comparison in a US population.

中文翻译：

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特利加压素与米多君加奥曲肽治疗肝肾综合征-急性肾损伤：倾向评分匹配比较。

目的 在美国人群中比较肝肾综合征-急性肾损伤 (HRS-AKI) 治疗的证据有限。特利加压素加白蛋白与米多君和奥曲肽加白蛋白 (MO) 的间接比较可以进一步了解治疗效果。方法 接受 HRS-AKI 治疗的患者队列的特征是血清肌酐 [SCr] < 5 mg/dL、基线慢加急性肝衰竭 (ACLF) 0-2 级，并且如果 MELD ≥ 35 则排除列入移植的患者汇总自 1) CONFIRM 和 REVERSE 随机对照试验（N=159 名符合接受特利加压素治疗的 N=216 名患者的资格标准）和 2) 对美国 10 家三级医院的医疗记录进行回顾性审查（2016-2019 年；N=55 名接受特利加压素治疗的患者） MO 符合资格标准（总体 N=200）。比较两个队列的主要终点是 HRS 逆转，定义为治疗期间至少一次达到 SCr ≤1.5 mg/dL。协变量平衡倾向评分用于调整基线特征的差异。结果 特利加压素治疗的患者中有 52.35% 实现了 HRS-AKI 逆转，而 MO 治疗的患者只有 20% [调整后的平均差（95% 置信区间）= 32.35% (17.40, 47.30), p<.0001]。特利加压素患者的总生存期有所增加（调整后的HR=0.57（0.35,0.93），p=0.02），但无移植生存期相似（调整后的HR=0.79（0.53,1.17），p=0.24）。无论治疗如何，HRS-AKI 逆转的实现与 OS 和 TFS 的增加相关 (p <0.001)。结论 根据美国人群的间接比较，与之前的报告一致，特利加压素加白蛋白在改善肾功能和实现 HRS-AKI 逆转方面比 MO 加白蛋白更有效。