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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).


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.


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.


In this study, we failed to prove non-inferiority between a low and high target MAP in patients with HRS.


This trial was registered with and approved by the University of Louisville Internal Review Board and hospital research review committees (IRB # 14.1190). The trial was registered with (ID # NCT02789150).


Varajic B1, Cavallazzi R2, Mann J2, Furmanek S3, Guardiola J2, Saad M2. J Crit Care. 2019 Apr 15;52:186-192. doi: 10.1016/j.jcrc.2019.04.006. [Epub ahead of print]

Author Information

1.  Department of Internal Medicine, University of Louisville, USA. Electronic address:

2.  Department of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, USA.

3.  Department of Infectious Disease, University of Louisville, USA.

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