الفهرس 
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Abstract
Summary and conclusion
Spontaneous bacterial peritonitis is the most important risk factor for HRS. One third of patients with SBP will develop HRS despite appropriate treatment with non-nephrotoxic antibiotics (Fasolato et al., 2007). The aim of our study was to evaluate the effects of different therapeutic modalities on systemic, hepatic and renal hemodynamics in high-risk patients with SBP. Two hundred and fifty cirrhotic patients with SBP and serum bilirubin > 4 mg/dL or creatinine > 1 mg/dL were enrolled. Cefotaxime was given intravenously in doses of 2 g/12 hours. These patients were randomized to five equal groups; Albumin group ”standard dose albumin”; albumin was given at a dose of 1.5 g per kilogram of body weight during the first six hours after enrollment, followed by 1 g per kilogram on day 3;Terlipressin group, terlipressin 1 mg/6 hours was given by intravenous injection for 3 days; Low dose Albumin plus Terlipressin group, albumin was given at a dose of 10 g /12 h for 3 days and terlipressin at a dose 1 mg/6 hours by intravenous injection for 3 days group IV; HES 130/0.4 group (Voluven®) was given at a dose of 1.5 g per kilogram of body weight during the first six hours after enrollment, followed by 1 g per kilogram on day 3; Midodrine group, midodrine was administered orally at the dosage of 10 mg/8 hours for 10 days.
Systemic, renal and hepatic hemodynamics, renal profile and plasma renin activity were measured at day 0, 3 and 10 in all groups. Renal failure and mortality were determined after 10 and 30 days in the studied groups.
We found that:
• Renal failure in Terlipressin, low dose Albumin plus Terlipressin & Midodrine group were comparable to the Albumin group after 10 and 30 days from admission. On the other hand, renal failure was significantly higher in HES 130/0.4 group after 10 and 30 days compared to Albumin group.
• The in-hospital mortality in Terlipressin, low dose Albumin plus Terlipressin & Midodrine group were comparable to Albumin group (P >0.05), while among HES 130/0.4 group mortality rate was significantly higher than Albumin group. After one month, the mortality rate in all groups was comparable to Albumin group.
• Terlipressin and low dose Albumin plus Terlipressin improve systemic hemodynamic and significantly decrease portal blood flow than Albumin group. But, there was no significant difference between this groups and Albumin as regards to renal profile, PRA, renal and hepatic arterial resistance.
• There were a significant deterioration in systemic, hepatic and renal hemodynamics and significant increase of plasma renin activity in high-risk SBP patients receives HES 130/0.4 compared with Albumin.
• Midodrine administration improves systemic hemodynamics in high-risk SBP patients but there was significant deterioration of hepatic and renal hemodynamics and significant increase of plasma renin activity in comparison to Albumin group.
• The independent predictors of in-hospital renal impairment in high-risk SBP patients were basal renal failure, lacked resolutions of SBP, MELD Na ≥31 and line of treatment (not include Albumin, Terlipressin or low dose Albumin plus Terlipressin).
• The independent predictors of in-hospital mortality were basal renal failure, lacked resolutions of SBP, thrombocytopenia, MELD Na ≥31 and line of treatment (not include Albumin, Terlipressin or low dose Albumin plus Terlipressin).