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. (C) 2019 Elsevier Inc. All rights reserved.