5 mg/dL at day 3, compared with only five of the 22 patients (23%) in whom serum creatinine did not decrease 0.5 mg/dL or increased at day 3 compared with baseline (P = 0.001). Similar figures were observed when the cutoff value of change in serum creatinine used was 1 mg/dL instead of 0.5 mg/dL (80% and 36%, respectively; P = 0.016). The value of the reduction in serum creatinine at day 3 as predictor of response to therapy was confirmed in a multivariate analysis (odds ratio, 6.5; P = 0.047). Thirty-five patients (90%) developed a total of 43 major complications of cirrhosis during

treatment: 31 cases of hepatic encephalopathy, nine cases of bacterial infection, and three cases of gastrointestinal bleeding. There was no significant difference BMS-354825 supplier between the frequency of bacterial infections between nonresponders and responders (33% versus 11% , respectively; P = 0.10). The development of bacterial infections during treatment with terlipressin and albumin was slightly more frequent (yet not significantly different) in patients with a baseline leukocyte count above the median value of 7,900/mm3 than in those with a leukocyte count below the median value (32% versus 15% , respectively; P = 0.27). Patients with a baseline leukocyte count above the median value developed pneumonia (n = 3), sepsis (n = 2), and spontaneous

bacterial peritonitis (n = 1) after a mean of 5 days (range, 2–13 days), whereas patients with Cyclic nucleotide phosphodiesterase a baseline leukocyte count below the median value developed urinary tract infections (n = 2) Selleck LY2606368 and pneumonia (n = 1) after a mean of 5 days (range, 2–8 days). It should be noted that none of these patients had proven bacterial infection at the time of initiation of therapy with terlipressin and albumin. Eleven patients (28%) developed

side effects likely related to treatment with terlipressin and albumin. Five patients developed signs of circulatory overload, which improved after temporary suppression of albumin together with administration of furosemide and did not require discontinuation of terlipressin. Two patients developed abdominal signs suggestive of intestinal ischemia (one of which was associated with circulatory overload), which subsided after discontinuation of treatment. Two patients developed transient arrhythmia (bradycardia and ventricular extrasystolia, respectively) that did not require permanent treatment discontinuation. One patient developed myocardial infarction and signs suggestive of intestinal ischemia (associated with circulatory overload). One patient developed signs of tongue ischemia. In the two latter patients, symptoms disappeared after treatment withdrawal. Three months after the start of therapy, 28 (72%) patients had died, four (10%) had undergone transplantation, five (13%) were alive, and two (5%) were lost to follow-up.