Comparison of Terlipressin vs Noradrenaline Through Assessment of Respiratory Parameters, Lung Ultrasound Scores, and RALES Score in Patients With Hepatorenal Syndrome – A Comparative Randomized Controlled Study

Hepatorenal syndrome (HRS) is a kidney injury caused by renal vasoconstriction due to systemic and splanchnic arterial vasodilation in advanced cirrhosis. Goal-directed therapy with albumin increases blood volume and cardiac output without affecting central venous pressure, helping maintain circulation and kidney perfusion. The ideal HRS treatment would selectively dilate renal blood vessels without affecting other circulations, especially splanchnic vessels. Both terlipressin and noradrenaline are effective vasoconstrictors for HRS. However, terlipressin may cause severe respiratory failure in volume overload, grade 3 acute-on-chronic liver failure, or pre-existing respiratory compromise. Rapid albumin administration can also worsen conditions like congestive heart failure, chronic kidney disease, and chronic liver disease. Point-of-care ultrasound (POCUS) enables bedside assessment of fluid status and organ function, helping prevent complications and guide treatment decisions. Lung ultrasound and venous excess scores can indicate fluid overload, aiding in diuretic or inotropic adjustments. The RALE score assesses lung edema severity on chest X-rays and predicts ARDS severity and outcomes. This study aims to correlate lung ultrasound and RALE scores with fluid overload in HRS patients receiving noradrenaline or terlipressin with albumin.