Five randomised controlled trials (RCTs, n=252 patients) were included in the review, with sample sizes ranging from 18 to 112 participants. One RCT had a cross-over design. Two RCTs were double-blinded and two were single-blinded (details not reported for the remaining trial).
The pooled odds ratios for hepatorenal syndrome reversal (OR 8.09, 95% CI 3.521 to 18.59; five RCTs) and survival (OR 2.064, 95% CI 0.939 to 4.538) indicated benefit after treatment with terlipressin. Both funnel plots indicated the possibility of publication bias. The pooled odds ratio for severe ischaemic events was 2.907 (95% CI 1.094 to 7.723; three RCTs), with no significant publication bias detected. No statistically significant heterogeneity was found for any of the results.
A sensitivity analysis, which excluded the trial not using albumin expansion, resulted in a similar effect size for hepatorenal syndrome reversal (OR 7.3, 95% CI 3.077 to 17.377; four RCTs).