{
  "abstract": "Introduction In HRS-AKI, terlipressin improves reversal rates in trials (e.g., CONFIRM), but real-world effectiveness and respiratory adverse events remain uncertain. Following CONFIRM, the MHRA issued recommendations to reduce risks of respiratory failure. We evaluated outcomes in a dual-site University Hospitals Birmingham (UHB) cohort and explored associations with regimen (bolus vs continuous) and albumin dosing.Methods Retrospective cohort audit of adult inpatients treated with terlipressin for HRS across two UHB sites (01/09/2023–30/09/2024; n=49). Outcomes were HRS resolution, inpatient mortality, renal replacement therapy (RRT), and adverse events ≤30 days, including respiratory failure (pulmonary oedema, hospital-acquired pneumonia or pleural effusion). Respiratory failure was analysed using logistic regression for total albumin during terlipressin (per 50 g) and albumin intensity, adjusting for MELD score, ICU admission, and regimen. Albumin intensity (daily albumin dose; g/day) was defined as total albumin administered during terlipressin divided by terlipressin treatment duration (days), and was analysed per 10 g/day increase. Predictors of inpatient mortality were assessed using multivariable logistic regression (age, MELD, ICU admission, regimen).Results Median age was 58 years (IQR 53–65) and median MELD at terlipressin initiation was 25.5 (IQR 18–31). Median serum creatinine was 149 µmol/L on admission (IQR 95–216) and 191 µmol/L at initiation (IQR 132–271). Terlipressin was bolus in 40/49 (81.6%) and continuous infusion in 9/49 (18.4%) for a median 4 days (IQR 2–8; range 1–24). Albumin was co-administered in 47/49 (95.9%); median albumin during terlipressin was 65 g (IQR 40–160) and total albumin before and during terlipressin was 105 g (IQR 60–260). HRS resolution occurred in 16/49 (32.7%), inpatient mortality in 24/49 (49.0%), RRT in 8/49 (16.3%), and respiratory failure in 20/49 (40.8%). Ischaemic adverse events were uncommon (IHD 1/49 [2.0%], PVD 0/49 [0%]). Mortality was 46.2% with bolus dosing vs 66.7% with continuous infusion, while respiratory failure was 47.5% vs 11.1%, respectively; the study was not powered to detect statistically significant differences between regimens. Total albumin during terlipressin was not associated with respiratory failure (adjusted OR 1.209 per 50 g, p=0.246), whereas albumin intensity was independently associated with respiratory failure (aOR 1.57 per 10 g/day, p=0.044); ICU admission was the strongest predictor (OR 8.118, p=0.023). Increasing age was the only independent predictor of inpatient mortality (aOR 1.078 per year, p=0.021).Conclusions In this dual-site real-world cohort, HRS resolution was similar to trial data but respiratory failure was common. Higher albumin intensity and ICU admission were independently associated with respiratory failure, supporting careful albumin titration and close monitoring of high-risk patients in line with MHRA safety recommendations.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Anmol Chikhlia"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Zeeshan Pervaiz"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Asif Yasin"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Luqmaan Rashid"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Noor Ul Hakeem"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Moazzam Ali"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Nasir Mir"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Faisal Khan"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Dhiraj Tripathi"
    }
  ],
  "title": "P80 Terlipressin for HRS-AKI: resolution and respiratory complications in a dual-site UHB retrospective cohort",
  "uid": "b55e56c7-504b-526d-94a2-ca6423c5166c"
}