Efficacy of midodrine plus octreotide in hepatorenal syndrome: a meta-analysis

Abstract

Hepatorenal syndrome (HRS) is a type of renal failure occurring in patients with cirrhosis, ascites and liver failure. Among the pharmacological treatment available, terlipressin has been found to be most efficacious vasoconstrictor agent in improving renal function. Though terlipressin has significant HRS reversal benefits, it lacks long term mortality benefits. Evidences on mortality benefits and renal failure reversal efficacy of midodrine plus octreotide in HRS are insufficient and controversial. The primary and secondary objectives of the study were to analyze mortality benefits and HRS reversal efficacy of midodrine plus octreotide in HRS respectively. Electronic databases were searched for the relevant articles in PUBMED, The Cochrane Register for Controlled trials, SCIRUS and Google scholar with MeSH search terms‘midodrine’ ‘octreotide’ and ‘hepatorenal syndrome’. Studies comparing mortality benefits of midodrine plus octreotide with control group were eligible to be included under analysis. Of the total 26 studies found relevant and deemed further screening only three studies met the eligibility criteria and were included in analysis. With total 309 patients included in analysis there was significant decrease in odds of occurrence of death at three months (Odds Ratio, OR = 0.17; 95% CI= 0.03 to 0.96) in midodrine plus octreotide treated group. Results of the study suggest that mortality benefits of midodrine plus octreotide appear to be significant even at three months. Though HRS reversal efficacy of this combination remains inconclusive, this combination may have HRS reversal benefits in terms of retarding the progression of the HRS rather than reversing it.