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The effects of vasopressin and its analogues on the liver and its disorders in the critically ill

Asfar, Pierrea,b; Radermacher, Peterc; Calès, Paula,d; Oberti, Frédérica,d

Current Opinion in Critical Care: April 2010 - Volume 16 - Issue 2 - p 148–152
doi: 10.1097/MCC.0b013e328335a35b
Gastrointestinal system: Edited by Peter Radermacher

Purpose of review: Vasopressin and terlipressin, a long-acting V1a analogue, are increasingly used in intensive care. The main clinical indications are the treatment of patients with septic shock and of patients with cirrhosis, who develop variceal bleeding, the hepatorenal syndrome or both. In this review, we summarize the effects of these drugs on splanchnic hemodynamics and organ function.

Recent findings: A recent systematic meta-analysis of randomized trials suggests that terlipressin may improve renal function in hepatorenal syndrome and thereby reduce mortality by 34%. Moreover, a recent study reported that association of terlipressin and albumin was more effective than terlipressin alone. In patients with variceal bleeding, the bleeding control is significantly improved by early administration of terlipressin. The place of vasopressin in the treatment of patients with septic shock is still discussed, but compared with norepinephrine, vasopressin showed at least an equal efficacy.

Summary: The use of vasopressin and its synthetic analogues has shown beneficial effects in the management of patients with cirrhosis, especially in the context of variceal bleeding, the hepatorenal syndrome or both. In both cases, the use of terlipressin improved survival. Therefore, in these clinical indications, terlipressin is a part of recommendations. The role of vasopressin in patients with septic shock remains to be precisely evaluated.

aLaboratoire HIFIH, UPRES EA 3859, IFR 132, Université d'Angers, PRES UNAM, France

bDépartement de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, Angers, France

cSektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Klinik für Anästhesiologie, Universitätsklinikum, Ulm, Germany

dService des maladies du foie et de l'appareil digestif, Centre Hospitalier Universitaire, Angers, France

Correspondence to Pierre Asfar, MD, PhD, Département de Réanimation Médicale et de Médecine Hyperbare, Centre Hospitalier Universitaire, 49933 Angers, Cedex 09, France Tel: +33 2 41 35 38 15; fax: +33 2 41 35 40 83; e-mail: piasfar@chu-angers.fr

© 2010 Lippincott Williams & Wilkins, Inc.