Effect of Terlipressin Versus Octreotide/Midodrine on Mortality in Patients With HRS

Introduction: Terlipressin is a vasopressin analogue that is approved by the Federal Drug Administration (FDA) to improve kidney function in adults with hepatorenal syndrome (HRS) with rapid reduction in kidney function. This study examines the effect of terlipressin (T) compared to octreotide and midodrine (MO) on mortality in patients with HRS.


Methods: This single-center, retrospective, cohort study was conducted at a tertiary academic medical center that was approved by the local institutional review board. Data was collected from the electronic medical record for patients admitted from July 2018 to July 2025 with patients ≥18 years of age admitted with ICD-9 code for cirrhosis, acute kidney injury and clinical diagnosis of HRS. Albumin was administered to all patients and use of terlipressin was administered based on the FDA-approved dosing regimen. Response to intervention was defined as at least a reduction in serum creatinine from baseline. Descriptive statistics were performed and student t-test, Fisher’s exact test, χ-square test and Mann Whitney U test were conducted, where appropriate.


Results: A total of 49 T patients were identified along with 30 MO patients. Patients in the MO group were younger 58.3±14 vs. 52.1±14 years, p< 0.005; with 59.2% males vs. 40%, p=0.098. There was greater mortality in MO patients (21/30 vs. 12/49, p< 0.05) vs. T patients. There was also greater mean total hospital length of stay (21.7±14 vs. 15.5±8.4, p=0.025) and baseline serum creatinine (3.06±1.2 vs. 1.89±1.0, p< 0.01 in T vs. MO patients. Higher number of T patients had a response than MO (30/49 vs.12/30, p=>0.05) with similar decrease in SrCr -34.8±21% vs. -36.1±21%, p=0.86). The number of days from start of therapy until the lowest serum creatinine was lower in the T group 4.97±3.5 days vs. 7.92±3.7 days, p=0.02).


Conclusions: Terlipressin appears to have efficacy in improving renal function and mortality n patients with HRS when compared to the current regimen of MO. Additional larger studies would be needed to confirm the efficacy of terlipresin in improving renal function and reversing HRS.