Published online Aug 7, 2017. doi: 10.3748/wjg.v23.i29.5379
Peer-review started: January 19, 2017
First decision: February 23, 2017
Revised: March 10, 2017
Accepted: April 21, 2017
Article in press: April 21, 2017
Published online: August 7, 2017
Processing time: 199 Days and 23.6 Hours
To investigate the factors influenced the efficacy of tolvaptan (TLV) in liver cirrhosis.
We retrospectively enrolled 61 consecutive patients with refractory hepatic ascites. All of them had been treated with furosemide and spironolactone before admission, and treated with TLV for 7 d in our hospital. The effect of TLV was defined by the rate of body weight loss, and the factors that influenced TLV efficacy were analyzed using multiple regression.
Coexistent hepatocellular carcinoma (HCC) was the only significant predictive variable that attenuated the efficacy of TLV. In stratified analysis, high doses of furosemide decreased the efficacy of TLV in patients with HCC, and increased efficacy in those without HCC. In the latter, a high Child-Pugh-Turcotte score had a positive influence and a high concentration of lactate dehydrogenase had a negative influence on the effectiveness of TLV.
Development of ascites may differ between patients with liver failure and those with HCC progression. A sufficient preceding dose of furosemide decreases diuretic effect of TLV.
Core tip: Efficacy of tolvaptan (TLV) for hepatic ascites has been confirmed but some patients are resistant to the drug. We investigate influencing factors of the efficacy of TLV. As a result, coexistent hepatocellular carcinoma (HCC) was the only significant predictive variable that attenuated the efficacy of TLV. In stratified analysis, high doses of furosemide decreased the efficacy of TLV in patients with HCC, and increased efficacy in those without HCC. This study suggests that development of ascites may differ between patients with liver failure and those with HCC progression. A sufficient preceding dose of furosemide decreases diuretic effect of TLV.