Ten RCTs (n=376 patients) were included in the review. Overall trial quality was poor. Three of the ten trials adequately reported randomisation and allocation concealment. Three trials reported double-blinding; one trial reported single blinding. All but one trial included 52 participants or less.
Vasoconstrictor drugs alone or with albumin significantly reduced mortality (RR 0.82, 95% CI 0.70 to 0.96; six trials), increased the proportion of patients with reversal of hepatorenal syndromes (RR 3.76, 95% CI 2.21 to 6.39; four trials), or improved renal function (RR 2.00, 95% CI 1.11 to 3.62; four trials), compared with no intervention or albumin. No significant heterogeneity was detected.
Subgroup analysis found a beneficial effect of terlipressin alone or with albumin (RR 0.80, 95% CI 0.66 to 0.97). Subgroup analysis of patients with type 1 hepatorenal syndrome showed a beneficial effect for vasoconstrictor drugs plus albumin (RR 0.77, 95% CI 0.61 to 0.98).
Treatment groups had significantly higher risk of cardiovascular events (RR 9.00, 95% CI 2.14 to 37.85), but a no significant increased risk of abdominal pain and diarrhoea (RR 6.82, 95% CI 0.79 to 59.15). No significant heterogeneity was observed. There were no differences between treatment and control groups for any of the remaining adverse events, such as hepatic encephalopathy and bacterial infections.
Post-hoc analysis suggested that the effect on mortality was seen at 15 days (RR 0.60, 95% CI 0.37 to 0.97), but not at 30 days (RR 0.74, 95% CI, 0.40 to 1.39), 90 days (RR 0.89, 95% CI 0.66 to 1.22), or 180 days (RR 0.83, 95% CI 0.65 to 1.05).