In liver cirrhosis, ascites is prone to developing hepatorenal syndrome (HRS) and acute kidney injury (AKI).1 Terlipressin should be a mainstay choice of pharmacological treatment for HRS-I.2,3 However, no definite recommendation regarding terlipressin to prevent from HRS and AKI in such patients has been given yet.1,4 Pilot studies suggest that terlipressin may be potentially beneficial for improving the severity of ascites and preventing from postparacentesis circulatory dysfunction.5,6 Herein, we have conducted a questionnaire survey to evaluate the contemporary real-world use of terlipressin in cirrhosis with ascites.
Methods
A questionnaire survey was conducted through an online questionnaire in August 2019. Thirty-three gastroenterologists and hepatologists from 30 hospitals in 15 provinces and municipalities in China participated in the questionnaire survey, after they were informed. They were invited to complete this questionnaire survey including 21 questions in truth. These questions are mainly divided into 3 major sections: (1) the information of participants; (2) the treatment of patients with cirrhosis and ascites; and (3) the use of terlipressin in cirrhosis with ascites. Bar charts were drawn to clearly show the main results proportionally.
Results
A majority of participants were chief physicians or vice-chief physicians (90.9%). All of them worked at tertiary hospitals (100%). There were more than 150 patients with liver cirrhosis and ascites every year at 63.6% of participants’ departments.
Twenty-nine participants used terlipressin in patients with cirrhosis and ascites and completed all of the 21 questions; and 4 participants had never used terlipressin in patients with cirrhosis and ascites and could not respond to 4 questions that were relevant to use of terlipressin.
In the cases where ascites is resistant to diuretics or patients cannot be treated with diuretics, 63.64% (21/33) of participants liked to select terlipressin (Figure 1).
Figure 1.
Selection of treatment approaches in the cases where ascites is resistant to diuretics or patients cannot be treated with diuretics.
Among the 29 participants who used terlipressin in patients with cirrhosis and ascites, 14 (48%) participants treated more than 30 patients with cirrhosis and ascites by terlipressin; major causes for use of terlipressin included the following: the severity of ascites was not improved by traditional diuretic treatment (24/29, 82.76%), renal impairment developed during the traditional diuretic treatment (24/29, 82.76%), increase of urine output (6/29, 20.69%), and all believed that terlipressin was effective for management of ascites in patients with cirrhosis (29/29, 100%).
Based on this questionnaire survey, many clinicians have considered terlipressin as an add-on choice of treatment for ascites in patients with cirrhosis. Therefore, a multicenter study is valuable to further explore the efficacy of terlipressin in patients with cirrhosis and ascites.
Author contributions (CRediT)
X.Q. contributed to conceptualization of the study. Z.B. and X.Q. contrbuted to methodology of the study. Z.B. contributed to analysis of the study using software. X.Q., X.G., and H.L. contributed to validation of the study. Z.B. and X.Q. contributed to formal analysis of the study; investigation of the study; data curation of the study; and writing–original draft of the study. Z.B., X.Q., X.G., and H.L. contributed to writing and editing the review. Z.B., X.Q., X.G., and H.L. contributed to visualization of the study. X.Q., X.G., and H.L. contributed to supervision of and project administration the study. All authors have made an intellectual contribution to the manuscript and approved the submission.
Conflicts of interest
The authors have no conflicts of interest to declare.
References
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