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Published on: September 13, 2014
Use of terlipressin in critically ill children with liver disease
Romit Saxena1, Aravind Anand1, Akash Deep2
1Paediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
Insights
Terlipressin is safe for critically ill children with liver disease and acute kidney injury, showing positive effects on renal function. Further studies are needed to confirm its impact on outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Hepatology
Background:
- Terlipressin, a vasopressin analogue, is established for adult indications like hepatorenal syndrome (HRS-AKI) and variceal bleeding.
- Pediatric use of terlipressin is limited, with scarce data on its safety and efficacy in children.
Purpose of the Study:
- To evaluate the safety and efficacy of terlipressin in pediatric patients with liver disease and acute kidney injury.
- To assess the drug's impact on renal parameters and adverse events in this population.
Main Methods:
- Retrospective review of pediatric patient records (January 2010-December 2017) from a Paediatric Intensive Care Unit (PICU).
- Analysis focused on terlipressin administration, renal function parameters (serum creatinine, urine output), and adverse events.
- Included 16 patients with 21 terlipressin administrations.
Main Results:
- Terlipressin administration led to a sustained increase in mean arterial pressure.
- Observed improvement in serum creatinine and increased urine output, particularly in the hepatorenal syndrome subgroup.
- Minimal gastrointestinal and vasoconstrictive side effects were noted.
Conclusions:
- Terlipressin appears safe in critically ill children with liver disease and acute kidney injury.
- The drug demonstrated a positive impact on renal parameters, potentially indicating HRS reversal.
- Further prospective studies are warranted to validate these findings and assess clinical outcomes.
Background:
Terlipressin, a long-acting synthetic analogue of vasopressin has been used in the adult population for various indications including hepatorenal syndrome (HRS-AKI), esophageal variceal hemorrhage (EVH) and shock, but its use in pediatrics is still limited to individualized cases and data on safety and efficacy is scant.
Methods:
We reviewed the patient records of children with liver disease and Acute Kidney Injury requiring terlipressin admitted to the Paediatric Intensive Care Unit (PICU) of King's College Hospital, London from January 2010-December 2017, with special emphasis on its effect on renal parameters and adverse event profile.
Results:
Twenty-one terlipressin administration records in a total of 16 patients (median) (IQR) 10 years (6.1-14.4) were included. The drug was initially given as a bolus dose in all cases, followed by either bolus or infusion with median dosage being 5.2 (3.8-6.7) mcg/kg/hour. After administration, a sustained increase of mean arterial pressure was observed. There was an improvement in serum creatinine (Cr) (at 24 h; p = 0.386) and increase in urine output (UO), especially in the hepatorenal syndrome subgroup (HRS-AKI). We found minimal evidence of gastrointestinal side effects including feeding intolerance and vasoconstrictive side effects including cyanosis / ischaemia of extremities.
Conclusion:
Terlipressin was found to be safe in critically sick children with liver disease with positive impact on renal parameters which might be taken as a surrogate marker of HRS reversal, though effects on outcomes are difficult to ascertain. It is important to be aware of all its side-effects and actively watch for them. Future prospective studies are warranted to validate these findings.
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