Non-hemodynamic Effects of Terlipressin in Patients with Acute Variceal Bleeding: A Prospective Pilot Study

Background: While the hemodynamic effects of terlipressin on reduction hepatic venous pressure gradient are well known, there is a limited information available non- this drug in patients with acute variceal bleeding (AVB). The present study evaluated systemic inflammation and endotoxemia cirrhosis during an episode AVB. Methods: In prospective pilot study, peripheral blood sample was withdrawn from presenting AVB Day-2. Terlipressin administered as 1mg intravenously every 6 hours bolus dose. Prior to next dose, repeat withdrawn. both pre- post-terlipressin samples, interleukin-6 (IL-6), interleukin-1 (IL-1), tumor necrosis factor alpha (TNF α), C-reactive protein (CRP) (assessed indirectly by IgM anti- endotoxin antibody) were estimated compared individual patients. Results: 24 (mean Age- 45±12 years, 62.5%males) median Child- turcotte pugh score model for end stage liver disease 8±2 13.7±4.1 respectively studied. Upon administration, significant decline serum IL-1 levels [ pre-terlipressin- (928.84± 363.14) pg/ml vs post-terlipressin- (754.74 ±289.61) P= 0.003), IL6 pre-terlipressin-143.75 ng/ml (121.20-166.84) post-terlipressin-123ng/ml (99.5 -152.5), P<0.001), TNF-α (1.48± 0.35) post terlipressin- (1.22± 0.42) pg/ml, P=0.004] CRP Pre- (5.82 ± 1.44) post- 4.41± 1.21) ng/ml, 0.006]). Endotoxemia assessed anti-endotoxin antibody showed fall (rise concentration) after administration Pre-terlipressin- -27.14 (23.05 - 39.3) MMU/mL 31.98 (20.95 47.08) MMU/mL, P=0.02]. Conclusions: associated endotoxemia. Further studies larger size appropriate control group required demonstrate clinical relevance these non-hemodynamic terlipressin.