Summary of findings for the main comparison. Terlipressin compared to other vasoactive drugs for hepatorenal syndrome.
| Terlipressin compared to other vasoactive drugs for hepatorenal syndrome | ||||||
| Patient or population: people with cirrhosis and hepatorenal syndrome Setting: hospital Intervention: terlipressin Comparison: other vasoactive drugs | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with other vasoactive drugs | Risk with terlipressin | |||||
| Mortality (All‐cause) | Study population | RR 0.96 (0.88 to 1.06) | 474 (10 randomised clinical trials*) | ⊕⊝⊝⊝ Very lowa,b,c | Downgraded because of clinical heterogeneity, 8/10 randomised clinical trials were at high risk of bias and, the results of Trial Sequential Analysis. | |
| 601 per 1000 | 577 per 1000 (529 to 637) | |||||
|
Hepatorenal syndrome (Number of participants who did not achieve reversal of hepatorenal syndrome) |
Study population | RR 0.79 (0.63 to 0.99) | 394 (9 randomised clinical trials) | ⊕⊝⊝⊝ Very lowb,c,d | Downgraded because of clinical heterogeneity, all trials were judged as high risk of bias, and results of Trial Sequential Analysis. | |
| 560 per 1000 | 442 per 1000 (353 to 554) | |||||
| Serious adverse events | Study population | RR 0.96 (0.88 to 1.06) | 474 (10 randomised clinical trials) | ⊕⊝⊝⊝ Very lowb,c,d | Downgraded because of clinical heterogeneity, all trials were judged as high risk of bias, and results of Trial Sequential Analysis. | |
| 609 per 1000 | 585 per 1000 (536 to 646) | |||||
| Non‐serious adverse events: diarrhoea or abdominal pain, or both | Study population | RR 3.50 (1.19 to 10.27) | 221 (5 randomised clinical trials) | ⊕⊝⊝⊝ Very lowb,c,d | Downgraded because of clinical heterogeneity, all trials were judged as high risk of bias, and results of the Trial Sequential Analysis. | |
| 19 per 1000 | 65 per 1000 (22 to 190) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
aIn the assessment of mortality, we classified two randomised clinical trials at low risk of bias and eight at high risk of bias.
bThe randomised clinical trials were not designed for equivalence or inferiority analysis. The Trial Sequential Analysis showed that sample size did not reach the required information size for equivalence/inferiority meta‐analysis.
cClinical heterogeneity.
dWe classified all randomised clinical trials at high risk of bias in all non‐mortality outcomes.