Efficacy and safety of norepinephrine combined with albumin versus terlipressin combined with albumin in treatment of type 1 hepatorenal syndrome:A Meta-analysis

Objective To systematically review the efficacy and safety of norepinephrine combined with albumin versus terlipressin combined with albumin in the treatment of type 1 hepatorenal syndrome(HRS1). Methods Pub Med,EMBASE,Medline,Cochrane Library,CNKI,Wanfang Data,and VIP were searched for comparative studies on norepinephrine combined with albumin versus terlipressin combined with albumin in the treatment of HRS1. Quality assessment was performed for articles. Related indicators were extracted,including hepatorenal syndrome(HRS) reversal rate,mortality rate,incidence of adverse events,mean arterial pressure,and renal function,and Review Manager 5. 3 was used for data analysis. The chi-square test was used to determine the heterogeneity between studies. Odds ratio(OR) was used for the analysis of dichotomous variables,weighted mean difference(WMD) was used for the analysis of continuous variables,and 95% confidence interval(CI) was calculated for these two types of variables. Results A total of 6 randomized controlled trials which met the inclusion criteria were included,with a total sample size of 298 patients(149 patients in the norepinephrine + albumin group and 149 in the terlipressin + albumin group). The meta-analysis showed that there were no significant differences between the two groups in HRS reversal rate(OR = 0. 95,95% CI: 0. 6-1. 49,P = 0. 81),mortality rate(OR = 0. 84,95% CI: 0. 51-1. 41,P = 0. 51),incidence rate of adverse events(OR =0. 42,95% CI: 0. 16-1. 07,P = 0. 07),mean arterial pressure(standardized mean difference = 0. 05,95% CI:-0. 92 to 1. 03,P = 0. 92),and renal function. Conclusion Norepinephrine combined with albumin has similar efficacy and safety as terlipressin combined with albumin in the treatment of HRS1,and terlipressin can be replaced by norepinephrine in clinical practice when necessary.