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Increased serum C-reactive protein and decreased urinary aquaporin 2 levels are predictive of the efficacy of tolvaptan in patients with liver cirrhosis

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Please use this identifier to cite or link to this item:http://hdl.handle.net/2115/72459

Title: Increased serum C-reactive protein and decreased urinary aquaporin 2 levels are predictive of the efficacy of tolvaptan in patients with liver cirrhosis
Other Titles: Predictive factors of tolvaptan efficacy for LC
Authors: Nakai, Masato Browse this author
Ogawa, Koji Browse this author
Takeda, Rei Browse this author
Ohara, Masatsugu Browse this author
Kawagishi, Naoki Browse this author
Izumi, Takaaki Browse this author
Umemura, Machiko Browse this author
Ito, Jun Browse this author
Sho, Takuya Browse this author
Suda, Goki Browse this author →KAKEN DB
Morikawa, Kenichi Browse this author
Sakamoto, Naoya Browse this author →KAKEN DB
Keywords: CRP
soluble CD14
tolvaptan
urinary aquaporin 2
water retention
Issue Date: Feb-2018
Publisher: John Wiley & Sons
Journal Title: Hepatology Research
Volume: 48
Issue: 3
Start Page: E311
End Page: E319
Publisher DOI: 10.1111/hepr.12988
PMID: 28984014
Abstract: Aim: Water retention, hepatic ascites, and peripheral edema are significant problems in patients with liver cirrhosis (LC). Although furosemide and spironolactone are commonly used as treatment, they are often insufficient to treat hyponatremia and renal insufficiency in patients with LC. Tolvaptan (TVP) could provide an effective treatment alternative. However, predictive factors of a therapeutic response to TVP are unclear. Our aim was to examine clinical predictors of the response to TVP in patients with LC and water retention. Methods: Fifty-two patients were treated with TVP, with therapeutic effects judged by a decrease in body weight (>= 2 kg) and increase in urinary volume (>= 500 mL) within 7 days. Blood biochemical tests were carried out at baseline and post-treatment, including serum soluble CD14 (sCD14) and urinary aquaporin 2 (AQP2) levels. Clinical and laboratory predictive factors of a TVP response were evaluated by univariate and multivariate analyses. Results: The overall response to TVP was 55.8%. On univariate analyses, serum C-reactive protein (CRP) level, the neutrophil-to-lymphocyte ratio, urinary blood urea nitrogen, and urinary AQP2 were predictors of the TVP response, with only serum CRP retained on multivariate analysis. A higher serum sCD14 level was strongly associated with a non-response to TVP. A decrease in urinary AQP2 to undetectable level was associated with a response. Conclusion: Tolvaptan provides a rapid and strong effect to improve water retention in patients with LC. Baseline serum sCD14 and CRP levels are useful predictors of a response to TVP, with a decrease in urinary AQP2 during treatment indicating an early response.
Rights: This is the peer reviewed version of the following article: Nakai, M., Ogawa, K., Takeda, R., Ohara, M., Kawagishi, N., Izumi, T., Umemura, M., Ito, J., Sho, T., Suda, G., Morikawa, K., and Sakamoto, N. (2018) Increased serum C‐reactive protein and decreased urinary aquaporin 2 levels are predictive of the efficacy of tolvaptan in patients with liver cirrhosis. Hepatol Res, 48: E311–E319, which has been published in final form at https://doi.org/10.1111/hepr.12988. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Type: article (author version)
URI: http://hdl.handle.net/2115/72459
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 中井 正人

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