High versus low mean arterial pressures in hepatorenal syndrome: A randomized controlled pilot trial

There is controversy regarding the mean arterial pressure (MAP) goals that should be targeted in the treatment of hepatorenal syndrome (HRS.) We conducted a study to assess different MAP targets in HRS in the intensive care unit (ICU).
Materials and methods:  This is a prospective randomized controlled pilot trial. ICU patients had target mean arterial pressure (MAP) ≥ 85 mmHg (control arm) or 65–70 mmHg (study arm). Urine output and serum creatinine were trended and recorded.
Results:  A total of 18 patients were enrolled. The day four urine output in the high and low MAP group was 1194 (SD = 1249) mL/24 h and 920 (SD = 812) mL/24 h, respectively. The difference in day four – day one urine output was −689 (SD = 1684) mL/24 h and 272 (SD = 582) mL/24 h for the high and low MAP groups. The difference in serum creatinine at day four – day one was −0.54 (SD = 0.63) mg/dL and − 0.77 (SD = 1.14) mg/dL in the high and low MAP groups, respectively.
Conclusion:  In this study, we failed to prove non-inferiority between a low and high target MAP in patients with HRS.
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