Abstract：
BACKGROUND:The principle of treating-to-target has been successfully applied to many diseases with significant improvement in patient care and as a useful guidance for healthcare providers. Appreciation of the central role for arterial vasodilatation in the pathogenesis of hepatorenal syndrome (HRS) has led to routine use of vasoconstrictors in combination with albumin in patients with HRS. An appropriate target to guide such therapy, however, has not yet been established. AIMS:The purpose of the current study was to identify a suitable target that can predict clinical outcome and guide the medical management of type 1 HRS, a condition associated with very poor prognosis. METHODS:A total of 85 patients with type 1 HRS who received a combination therapy of vasoconstrictors and albumin were enrolled. A potential therapeutic target was identified by univariate and multivariate logistic regression analyses. The treat-to-target concept to guide the management of HRS was then tested via a retrospective cohort study. RESULTS:A change in mean arterial pressure (MAP) during treatment was identified as a sole independent predictor for patient survival. Compared with mild or no increase in MAP, achievement in a marked increase in MAP of more than 10 mmHg in these patients was associated with better overall survival and transplant-free survival. Increased MAP to higher than 15 mmHg did not result in further improvement in clinical outcome. CONCLUSIONS:A treat-to-target concept by the use of a specific goal of MAP is feasible and may potentially guide the medical management of type 1 HRS.
journal_name
Dig Dis Scijournal_title
Digestive diseases and sciencesauthors
Cai CX,Maddukuri G,Jaipaul N,Zhang Zdoi
10.1007/s10620-014-3483-xsubject
Has Abstractpub_date
2015-05-01 00:00:00pages
1474-81issue
5eissn
0163-2116issn
1573-2568journal_volume
60pub_type
杂志文章abstract：:Gastroesophageal reflux disease has frequently been implicated in a wide variety of complications beyond the esophagus. These so-called "extraesophageal" disorders range from diseases of the respiratory tract, such as asthma and bronchitis, to more remote sites and conditions such as otitis and dental erosion. Many ar...
journal_title：Digestive diseases and sciences
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pub_type： 临床试验,杂志文章
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journal_title：Digestive diseases and sciences
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pub_type： 临床试验,杂志文章,随机对照试验
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journal_title：Digestive diseases and sciences
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