An Open Label, Pilot, Randomized Controlled Trial of terlipressin in icu Versus Terlipressin in ward in the Treatment of Type 1 Hepatorenal Syndrome through assessment of respiratory parameters,lung ultrasound scores and RALES score in patients and Predictors of Response.

Hepatorenal syndrome (HRS) is kidney injury caused by renal vasoconstriction due to systemic and splanchnic vasodilation in advanced cirrhosis. Albumin therapy increases central blood volume and cardiac index without affecting central venous pressure, helping maintain circulation and renal perfusion. Ideal HRS treatment would selectively vasodilate renal circulation without affecting other vascular beds. Both terlipressin and noradrenaline are effective vasoconstrictors. Unlike norepinephrine, terlipressin can be given peripherally and outside the ICU but may cause severe respiratory failure in patients with volume overload, acute-on-chronic liver failure (grade 3), or pre-existing respiratory compromise. Rapid albumin administration may worsen hypervolemic states like heart failure, CKD, and liver disease. Point-of-care ultrasound (POCUS) enables bedside physiological assessment. Lung ultrasound scores and venous excess scores help correlate fluid overload with organ function, preventing complications and improving outcomes. POCUS aids fluid management in sepsis and hypovolemia and supports clinical decisions regarding diuretics or inotropic therapy in AKI. The Radiographic Assessment of Lung Edema (RALE) score quantifies alveolar opacities on chest X-rays and independently predicts ARDS severity and outcomes. As terlipressin can be administered peripherally in wards, we aim to compare its side effect profile in ICU vs. ward settings. In the ICU, lung ultrasound is performed daily alongside RALE scoring, whereas it is less frequently used in wards. This study seeks to correlate lung ultrasound and RALE scores in predicting fluid overload in HRS patients receiving terlipressin and albumin in ICU vs. ward settings.