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Treatment of Type-1 Hepatorenal Syndrome with Pentoxifylline: A Randomized Placebo Controlled Clinical Trial
Jonathan G. Stine
,
Corresponding author
jstine@pennstatehealth.psu.edu

Corresponding author.
, Jennifer Wang**, Scott L. Cornella*, Brian W. Behm*, Zachary Henry*, Neeral L. Shah*, Stephen H. Caldwell*, Patrick G. Northup*
* Division of Gastroenterology & Hepatology, Department of Medicine, University of Virginia, Charlottesville, VA, United States
** Department of Medicine, University of Virginia, Charlottesville, VA, United States
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Hepatorenal syndrome &#40;HRS&#41; is a feared complication of chronic liver disease and cirrhosis presenting a unique challenge to physicians&#46; The incidence of Type 1 hepatorenal syndrome &#40;HRS-1&#41; in patients with cirrhosis and ascites is 18 and 39 &#37; at one and five years&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> HRS-1 occurs in the absence of underlying kidney disease and leads to renal failure secondary to compensatory renal vasoconstriction due to splanchnic arterial vasodilation and an ineffective interarteriolar blood volume&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The prognosis of HRS-1 is poor with median life expectancy around two weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Patients often decompensate and die prior to liver transplantation&#46; The current standard of care to treat HRS-1 in North America is the combination of albumin&#44; octreotide and midodrine &#40;AMO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Terlipressin in combination with albumin is also effective&#44; however&#44; this is not approved by the Food and Drug Administration or available currently in the United States&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Noradrenalin and albumin may also be used&#44; however this requires Intensive Care Unit monitoring which is not applicable for all patients or all hospitals&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Patients who develop HRS-1 and survive are more likely to have HRS recurrence&#46; After the withdrawal of treatment for HRS-1&#44; recurrence can occur in up to 20&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">Pentoxifylline &#40;PTX&#41; is a phosphodiesterase inhibitor with anti-inflammatory capabilities that lowers blood viscosity and improves erythrocyte flexibility&#46; Pro-inflammatory cytokines&#44; including tumor necrosis factor alpha &#40;TNFa&#41; and interleukin-6 are elevated in patients with cirrhosis in response to circulating endotoxemia&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> These cytokines lead to a pro-inflammatory&#44; hyperdynamic state&#46; PTX has been shown to not only decrease levels of TNFa&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> but also to increase systemic vascular resistance directly opposing splanchnic vasodilation without precipitating an increase in the pressure in the portal venous system&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Patients with HRS have even greater levels of TNF&#945; when compared to cirrhosis patients without HRS&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">Clinically&#44; PTX has been shown to be effective in preventing HRS in patients both with acute alcoholic hepatitis<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and cirrhosis&#59;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> however&#44; despite this&#44; no direct survival benefit has been observed&#46; To our knowledge&#44; no study to date has investigated adding PTX to the algorithm for the treatment of HRS-1 despite the benefit of PTX when used as primary prophylaxis&#46; We hypothesize that the addition of PTX to AMO is safe and efficacious when compared to AMO plus placebo in the treatment of HRS1 in hospitalized patients with decompensated cirrhosis&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Material And Methods</span><p id="p0020" class="elsevierStylePara elsevierViewall">Patients at the University of Virginia Health System hospitalized with decompensated cirrhosis and acute renal failure were screened for enrollment from July 2014 through June 2016&#46; HRS-1 was defined according to the criteria put forth by the American Association for the Study of Liver Disease as&#58;<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0025" class="elsevierStylePara elsevierViewall">Cirrhosis with ascites&#59;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0030" class="elsevierStylePara elsevierViewall">Serum creatinine greater than 1&#46;5 mg&#47;dL&#59;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0035" class="elsevierStylePara elsevierViewall">No improvement of serum creatinine &#40;decrease to a level of 1&#46;5 mg&#47;dL or less&#41; after at least two days with diuretic withdrawal and volume expansion with albumin&#59;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0040" class="elsevierStylePara elsevierViewall">Absence of shock&#59;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0045" class="elsevierStylePara elsevierViewall">No current or recent treatment with nephrotoxic drugs&#59; and</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0050" class="elsevierStylePara elsevierViewall">Absence of parenchymal kidney disease as indicated by proteinuria &#62; 500 mg&#47;day&#44; microhematuria &#40;&#62; 50 red blood cells per high power field&#41;&#44; and&#47;or abnormal renal ultrasonography&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></li></ul></p><p id="p0055" class="elsevierStylePara elsevierViewall">All participants were older than or equal to 18 years of age&#46; Patients with labeled contraindications to PTX were excluded &#91;allergy or hypersensitivity to PTX or intolerance to methylxanthines &#40;e&#46;g&#46; caffeine&#44; theophylline&#41;&#44; recent cerebral or retinal hemorrhage or pregnancy&#44; or if they had concurrent use of nephrotoxic drugs&#44; uncontrolled bacterial infection&#44; renal parenchymal disease &#40;e&#46;g&#46; acute tubular necrosis&#44; glomerular disease&#44; interstitial nephritis&#44; urinary obstruction&#41;&#44; shock&#44; TNF&#945; antagonist use&#44; severe or poorly controlled comorbid disease as determined by the principal investigator to hinder the ability of the subject to adhere to study protocols&#46; No institutionalized subjects or prisoners were enrolled&#46; No surrogate consent was obtained in subjects with uncontrolled hepatic encephalopathy&#46;</p><p id="p0060" class="elsevierStylePara elsevierViewall">Following enrollment&#44; each subject underwent a predosing medical history&#44; physical exam&#44; and safety assessment&#44; which included a review of laboratories&#44; imaging tests and procedural results performed during their hospitalization&#46; Subjects were blinded to the study investigators and medical care team and were randomized in 1&#58;1 ratio to either a 14-day course of PTX 400 mg three times a day or the equivalent dose adjusted for renal impairment &#91;400 mg twice a day for estimated glomerular filtration rate &#40;eFFR&#41; 10-50 mg&#47;dL and 400 mg once a day for eGFR &#60; 10 mg&#47; dL&#93; or to placebo&#46; On day three&#44; seven&#44; 10 and 14&#44; an indepth assessment for treatment response and review of side effect profile with medical history and physical exam was completed&#46; All adverse events&#44; including those that were serious&#44; were graded according to the National Cancer CTCAE version 4&#46;0&#46; If a patient was determined to be a &#8220;partial responder&#44;&#8221; as defined as serum creatinine level decreased by &#62; 50&#37; from baseline but not &#60; 1&#46;5 mg&#47;dL&#44; without dialysis or HRS recurrence&#44; the treating physician was allowed to continue therapy in a blinded fashion for an additional 14 days at their discretion&#46; If a patient was unable to swallow a pill for six consecutive doses&#44; they were withdrawn from the study as PTX cannot be administered through a gastric feeding tube due to its pharmacologic properties&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">The primary endpoint was the incidence of HRS-1 resolution&#44; which was defined as a decrease in serum creatinine level to &#60; 1&#46;5 mg&#47;dL for &#62; 24 h without dialysis or death&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Secondary endpoints assessed were change in serum creatinine from baseline to day 14&#44; change in Model for End Stage Liver Disease &#40;MELD&#41; score from baseline to day 14&#44; incidence of treatment failure on day 14 &#40;defined as creatinine level above baseline value after day seven&#44; renal replacement therapy or death&#41;&#44; partial response without dialysis or HRS recurrence&#44; transplant free survival at day 30 and 180 and overall survival at day 30 and 180&#46; MELD score was calculated using the standard formula &#40;<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>&#41;&#44; with a lower limit of 1&#46;0 for all variables&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Survival was assessed by telephone interview and a review of the medical record&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0070" class="elsevierStylePara elsevierViewall">All analyses were conducted based on the intention to treat methodology&#46; Results were expressed as means with standard deviations&#46; Chi-squared and Fisher s exact test were used to analyze categorical endpoints&#46; Student s t test and Mann-Whitney Rank Sum test were used for secondary analysis of differences in continuous lab data&#46; KaplanMeier curves were constructed for overall and transplant-free 180-day survival and compared by a logrank test to assess our secondary endpoints of survival&#46; Subjects were right-censored if they died&#44; were transplanted&#44; progressed to the need for renal replacement therapy or were lost to follow-up&#46; A p value of &#60; 0&#46;05 was considered significant&#46; Data analysis and graph generation were performed using SAS Version 9&#46;4 &#40;Cary&#44; North Carolina&#44; USA&#41; and GraphPad Prism version 7&#46;03 for Windows&#44; GraphPad Software &#40;La Jolla&#44; California&#44; USA&#41;&#46; Study approval was obtained from the University of Virginia Institutional Review Board for Health Sciences Research&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Results</span><p id="p0075" class="elsevierStylePara elsevierViewall">Twelve subjects with mean age 58&#46;9 &#177; 6&#46;2 years were enrolled and randomized&#44; six in the PTX &#43; AMO arm and six in the placebo &#43; AMO arm &#40;<a class="elsevierStyleCrossRef" href="#f0010">Figure 2</a>&#41;&#46; Overall cohort mean MELD score was 26&#46;5 &#177; 7&#46;4 and all subjects had Child-Pugh-Turcotte Class B &#40;n &#61; 2&#41; or C &#40;n &#61; 10&#41; liver disease&#46; 58&#46;3&#37; were male&#46; The leading etiologies of liver disease included alcoholic cirrhosis &#40;50&#46;0&#37;&#41; and nonalcoholic steatohepatitis &#40;25&#46;0&#37;&#41;&#46; One subject each with chronic hepatitis C&#44; hereditary hemochromatosis and autoimmune hepatitis was enrolled&#46; Overall cohort 30- and 180-day survival was 58&#46;3&#37; and 33&#46;3&#37; respectively&#46; Two subjects underwent liver transplantation&#44; one in the PTX group and one in the control group&#46; There were no clinically significant differences in baseline characteristics &#40;demographics&#44; liver disease etiology&#44; baseline laboratories&#44; medications&#44; HRS risk factors&#44; or manifestations of portal hypertension&#41; between the intervention and the control group&#44; although two PTX subjects had been prescribed AMO treatment in the previous week prior to transfer to our tertiary care institution for further medical care &#40;<a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>&#41;&#46; There was a trend towards significance in the use of acid suppressing medications in the standard of care group &#40;33&#46;3&#37; PTX <span class="elsevierStyleItalic">vs&#46;</span>83&#46;3&#37;&#44; p &#61; 0&#46;079&#41;&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0080" class="elsevierStylePara elsevierViewall">HRS-1 resolution was identical between the two groups with one subject in each arm &#40;16&#46;7&#37;&#41;&#46; No differences were seen in partial treatment response &#91;n &#61; 2 &#40;33&#46;3&#37;&#41; <span class="elsevierStyleItalic">vs&#46;</span> n &#61; 1 &#40;16&#46;7&#37;&#41;&#44; p &#61; 0&#46;505&#93;&#44; change in creatinine &#40;&#43;0&#46;48 g&#47;dL&#44; 95&#37; CI -0&#46;49-1&#46;46 <span class="elsevierStyleItalic">vs&#46;</span> &#43;0&#46;03 g&#47;dL&#44; 95&#37; CI 0&#46;64-0&#46;70&#44; p &#61; 0&#46;427&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0015">Figure 3</a>&#41;&#44; 30-day survival &#91;n &#61; 4 &#40;66&#46;6&#37;&#41; <span class="elsevierStyleItalic">vs&#46;</span> n &#61; 3 &#40;50&#46;0&#37;&#41;&#44; p &#61; 0&#46;558&#93; and 180-day survival &#91;n &#61; 3 &#40;50&#46;0&#37;&#41; <span class="elsevierStyleItalic">vs&#46;</span> n &#61; 1 &#40;16&#46;7&#37;&#41;&#44; p &#61; 0&#46;221&#93; &#40;<a class="elsevierStyleCrossRef" href="#f0020">Figure 4</a>&#41; when comparing PTX to the control group&#46; Mean survival &#40;102&#46;0 days&#44; 95&#37; CI 11&#46;7-192&#46;3 <span class="elsevierStyleItalic">vs&#46;</span> 58&#46;8 days&#44; 95&#37; CI 10&#46;9128&#46;5&#44; p &#61; 0&#46;357&#41; and mean transplant-free survival &#40;80&#46;2 days&#44; 95&#37; CI 2&#46;3-162&#46;7 <span class="elsevierStyleItalic">vs&#46;</span> 35&#46;8 days&#44; 95&#37; CI 4&#46;3-67&#46;3&#44; p &#61; 0&#46;226&#41; were also similar for PTX compared to control&#46; A significant difference was seen when looking at the change in MELD over the course of the entire study as the PTX group had a significantly greater increase in MELD score &#40;&#43;4&#46;2&#44; 95&#37; CI -2&#46;7 to &#43; 11&#46;0&#41; <span class="elsevierStyleItalic">vs&#46;</span> the AMO group &#40;&#43;0&#46;5&#44; 95&#37; CI -2&#46;0 to &#43;3&#46;0&#41; driven largely by the above mentioned change in creatinine&#44; p &#61; 0&#46;042 &#40;<a class="elsevierStyleCrossRef" href="#f0025">Figure 5</a>&#41;&#44; however both initial &#40;26&#46;0&#44; 95&#37; CI 22&#46;1-29&#46;9 PTX <span class="elsevierStyleItalic">vs&#46;</span> 27&#46;0&#44; 95&#37; CI 15&#46;7-38&#46;3&#44; p &#61; 0&#46;835&#41; and final MELD scores &#40;30&#46;5&#44; 95&#37; CI 21&#46;4-39&#46;6 PTX <span class="elsevierStyleItalic">vs&#46;</span> 28&#46;0&#44; 95&#37; CI 17&#46;5-38&#46;5&#44; p &#61; 0&#46;654&#41; were statistically similar&#46; No subjects were lost to follow-up&#46; Serious adverse events necessitating treatment discontinuation were rare&#46; One subject in the PTX group discontinued treatment due to significant nausea and vomiting which was later attributed to another concomitant medication&#46; No adverse events &#8805; grade 3 were documented in the AMO group&#46;</p><elsevierMultimedia ident="f0015"></elsevierMultimedia><elsevierMultimedia ident="f0020"></elsevierMultimedia><elsevierMultimedia ident="f0025"></elsevierMultimedia></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Discussion</span><p id="p0085" class="elsevierStylePara elsevierViewall">In a randomized&#44; placebo-controlled&#44; triple blinded pilot study&#44; we found that PTX&#44; when added to standard of care with volume expansion and vasoconstriction&#44; is a safe alternative to the standard of care alone&#46; This potential novel therapy is important to consider in light of the abysmal prognosis for cirrhosis patients who develop HRS-1&#44; especially those who are not eligible for liver transplantation where progression of disease more often than not leads to a palliative&#44; endof-life approach&#46;</p><p id="p0090" class="elsevierStylePara elsevierViewall">PTX has been shown previously to be effective in preventing HRS in patients with either acute alcoholic hepatitis or cirrhosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12</span></a>-<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In their study of 101 patients&#44; Akriviadis&#44; <span class="elsevierStyleItalic">et al&#46;</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> demonstrated that compared to placebo&#44; patients randomized to 400 mg PTX orally three times a day had a 71&#37; lower risk of developing HRS as a cause of death &#40;RR 0&#46;29&#59; 95&#37; CI 0&#46;13-0&#46;65&#44; p &#61; 0&#46;009&#41;&#46; More importantly&#44; the authors found improved survival &#40;24&#46;5&#37; <span class="elsevierStyleItalic">vs&#46;</span> 46&#46;1&#37; mortality&#44; p &#61; 0&#46;037&#59; RR 0&#46;59&#44; 95&#37; CI 0&#46;35-0&#46;97&#41;&#46; Our cohort was comprised of 50&#37; alcoholic cirrhosis subjects&#46; PTX is also effective in preventing HRS in patients with cirrhosis albeit with an attenuated effect&#46; In their randomized controlled trial of 335 patients with advanced cirrhosis&#44; Lebrec&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> demonstrated that the proportions of patients without a composite of complications&#44; including HRS&#44; were higher in the PTX group than the placebo group at two &#40;78&#46;6&#37; <span class="elsevierStyleItalic">vs&#46;</span> 63&#46;4&#37;&#44; p &#61; 0&#46;006&#41; and six months &#40;66&#46;8&#37; <span class="elsevierStyleItalic">vs&#46;</span> 49&#46;7&#37;&#44; p &#61; 0&#46;002&#41; respectively&#46; Furthermore&#44; the probability of being free of renal failure was statistically significant at 6 months in the PTX group &#40;90&#46;9&#37;&#44; 95&#37; CI 86&#46;1-95&#46;6&#41; <span class="elsevierStyleItalic">vs&#46;</span> the placebo group &#40;79&#46;4&#37;&#44; 95&#37; CI 72&#46;686&#46;1&#37;&#41;&#44; p &#61; 0&#46;02&#46; However&#44; there was no appreciable survival difference at 2 and 6 months between these two groups&#46; Similarly&#44; Tyagi&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> demonstrated that PTX is effective in preventing HRS in cirrhotic patients with ascites&#46; In their randomized placebo controlled trial of 70 patients&#44; 35 were given PTX with improvement in serum sodium&#44; mean arterial pressure and preservation of creatinine&#46; Of the 12 patients who developed HRS&#44; only two patients were in the PTX arm &#40;p &#61; 0&#46;01&#41;&#46;</p><p id="p0095" class="elsevierStylePara elsevierViewall">In general&#44; treatment related serious adverse events were rare&#46; The one patient who suffered a serious adverse event attributable to PTX had significant nausea and vomiting&#59; however&#44; this was in the setting of co-administration of tramadol&#44; a medication the subject remembered they had a similar reaction to when given prior but did not disclose as an allergy&#47;intolerance&#46; Thus&#44; the exact role of PTX in precipitating significant gastrointestinal side effects necessitating drug discontinuation remains unclear&#44; although nausea and vomiting have been reported in upwards of 28&#37; of patients taking PTX&#46; Other common side effects including dizziness&#44; headache&#44; dyspepsia and diarrhea<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> were not observed&#46;</p><p id="p0100" class="elsevierStylePara elsevierViewall">While we did not find a survival benefit in this study due to a small sample size &#40;we prematurely terminated study enrollment due to low numbers of recruitment over the two year study period&#41;&#44; our study was not powered to detect survival rate and there was a trend towards a survival benefit in the PTX group&#46; Overall cohort survival rate was higher than expected&#44; largely due to the frequency of liver transplantation in the setting of the relatively small sample size&#46; Future large-scale&#44; well-powered multicenter study may be considered to corroborate these findings&#46; Other limitations of our study are the inherent limitations to PTX as this medication cannot be administered through a gastric feeding tube owing to its pharmacologic properties&#46; This is problematic as oftentimes patients with advanced cirrhosis and HRS have significant hepatic encephalopathy which can impair their ability to take oral medications&#46; Additionally&#44; we excluded patients in the intensive care unit&#44; a setting where HRS patients often receive aggressive medical care&#46; This decision limits the generalizability of our findings somewhat and prevented a third comparison to patients who were prescribed the alternative HRS treatment regimen of norepinephrine and albumin&#46;</p><p id="p0105" class="elsevierStylePara elsevierViewall">In conclusion&#44; the addition of PTX to AMO in the treatment of HRS-1 is safe and may offer a well-tolerated novel treatment to the limited armamentarium for this highly morbid condition&#46; Future large-scale prospective study to validate the efficacy of this treatment seems warranted&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Guarantor of Article</span><p id="p0110" class="elsevierStylePara elsevierViewall">Jonathan G&#46; Stine&#44; M&#46;D&#46; MSc&#44; FACP</p></span><span id="s1030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Disclosure Statement</span><p id="p0115" class="elsevierStylePara elsevierViewall">The authors have nothing to disclose&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st1040">Financial Support</span><p id="p0125" class="elsevierStylePara elsevierViewall">This work was supported in part by grant funding from the National Institutes of Health &#40;Grant 5T32DK007769-15&#41;&#46;</p><p id="p0130" class="elsevierStylePara elsevierViewall">This work was also supported by a Transplant Hepatology Fellowship Award from the American Association for the Study of Liver Diseases &#40;AASLD&#41;&#46;</p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Sources of Support</span><p id="p0135" class="elsevierStylePara elsevierViewall">The sources of financial and material support had no role in the design or conduct of the study&#59; collection&#44; management&#44; analysis or interpretation of the data&#59; or preparation&#44; review or approval of the manuscript&#46;</p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Author Contributions</span><p id="p0140" class="elsevierStylePara elsevierViewall">Stine JG&#44; Henry Z&#44; Caldwell SH and Northup PG designed research&#59; Stine JG&#44; Wang J&#44; Cornella SL&#44; Behm BW&#44; Shah NL&#44; Northup PG performed research&#59; Stine JG and Northup PG analyzed data&#59; Stine JG&#44; Wang J&#44; Cornella SL&#44; Behm BW&#44; Henry Z&#44; Caldwell SH&#44; and Northup PG wrote and approved the final version of the paper&#46;</p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Potential Competing Interests</span><p id="p0145" class="elsevierStylePara elsevierViewall">None</p></span></span>"
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          "titulo" => "Introduction"
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    "fechaRecibido" => "2017-06-25"
    "fechaAceptado" => "2017-07-26"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Cirrhosis"
            1 => "Liver transplantation"
            2 => "Hepatology"
            3 => "Survival"
            4 => "Renal failure"
            5 => "Nephrology"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction&#46;</span> Type-1 hepatorenal syndrome &#40;HRS-1&#41; portends a poor prognosis in patients with cirrhosis&#46; Currently available medical therapies are largely ineffective&#44; save for liver transplantation&#46; We aimed to determine if pentoxifylline &#40;PTX&#41; therapy in addition to the standard of care of volume expansion with albumin and vasoconstriction with midodrine and octreotide &#40;AMO&#41; is safe and efficacious compared to AMO in HRS-1 treatment&#46;</p><p id="sp0135" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material and methods&#46;</span> Hospitalized subjects with decompensated cirrhosis and HRS-1 were enrolled&#46; PTX or placebo was administered with AMO therapy for up to 14 days&#46; The primary endpoint was HRS-1 resolution &#40;serum creatinine &#8804; 1&#46;5 g&#47;dL for &#62; 24 h&#41;&#46; Secondary endpoints were change in creatinine and MELD score&#44; partial treatment response&#44; 30-and 180-day overall and transplant free survival&#46;</p><p id="sp0235" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#46;</span> Twelve subjects with mean age 58&#46;9 &#177; 6&#46;2 years were enrolled and randomized&#46; Mean MELD score was 26&#46;5 &#177; 7&#46;4 and 58&#46;3&#37; were male&#46; Overall cohort 30- and 180-day survival was 58&#46;3&#37; and 33&#46;3&#37; respectively&#46; Two subjects underwent liver transplantation&#46; HRS-1 resolution &#40;16&#46;7&#37; <span class="elsevierStyleItalic">vs&#46;</span> 16&#46;7&#37;&#44; p &#61; 1&#46;000&#41;&#44; partial treatment response &#40;33&#46;3&#37; <span class="elsevierStyleItalic">vs&#46;</span> 16&#46;7&#37;&#44; p &#61; 0&#46;505&#41;&#44; change in creatinine &#40;&#43;0&#46;48 g&#47;dL&#44; 95&#37; CI -0&#46;49-1&#46;46 <span class="elsevierStyleItalic">vs&#46;</span> &#43;0&#46;03 g&#47;dL&#44; 95&#37; CI -0&#46;640&#46;70&#44; p &#61; 0&#46;427&#41;&#44; 30-day survival &#40;66&#46;6&#37; <span class="elsevierStyleItalic">vs&#46;</span> 50&#46;0&#37;&#44; p &#61; 0&#46;558&#41; and 180-day survival &#40;50&#46;0&#37; <span class="elsevierStyleItalic">vs&#46;</span> 16&#46;7&#37;&#44; p &#61; 0&#46;221&#41; were similar between the two groups&#46; Serious adverse events necessitating treatment discontinuation were rare &#40;n &#61; 1&#44; PTX&#41;&#46;</p><p id="sp1235" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Discussion&#46;</span> The addition of PTX to AMO in the treatment of HRS-1 is safe when compared to the current standard of care&#46; Future large-scale prospective study to validate the efficacy of this treatment seems warranted&#46;</p></span>"
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          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Change in renal function comparing the addition of pentoxyfylline to the standard of care&#46; No differences were observed between the two groups when assessing improvement in rena function following intervention&#46;</p>"
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            "Alto" => 224
            "Ancho" => 312
            "Tamanyo" => 6857
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Change in MELD Score&#46; The pentoxyfylline group experienced more heterogeneity with change in MELD score when stratified at the individual and group level&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "t0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="np0005" class="elsevierStyleSimplePara elsevierViewall">In general&#44; the two different study arms were similar in baseline characteristics&#44; safety and efficacy&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Standard of Care &#40;n &#61; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pentoxyfylline &#43; <a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#43;</span></a>Standard of Care &#40;n &#61; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;8 &#40;52&#46;5-69&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;0 &#40;52&#46;4-61&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ethnicity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caucasian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hispanic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liver disease etiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NASH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HCV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AIH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPT score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;83&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;83&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Laboratory values&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;0 &#40;15&#46;7-38&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;0 &#40;22&#46;1-29&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total bilirubin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8 &#40;0&#46;4-7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7 &#40;0&#46;8-4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Creatinine &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;0 &#40;2&#46;1-3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;6 &#40;2&#46;0-3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">INR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1 &#40;0&#46;8-3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1 &#40;1&#46;5-2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sodium &#40;mEq&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131 &#40;126-136&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131 &#40;127-136&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Albumin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;7 &#40;2&#46;7-4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6 &#40;3&#46;1-4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nonselective BB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPI&#47;HRA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;83&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AMO prior 7 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;3 &#40;65&#46;8-80&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;8 &#40;67&#46;8-83&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HRS risk factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Active GIB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diuretics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Portal hypertension decompensations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ascites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;100&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GEVs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatic encephalopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;83&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;83&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outcomes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HRS resolution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Progression to RRT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Serious adverse events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 day mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 day HRS recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">180 day mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;83&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">180 days HRS recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Partial response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liver transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean survival&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;11-129&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102 &#40;12-192&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean transplant-free survival&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;4-67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;2-163&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Change in laboratories&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Delta Creatinine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03 &#40;-0&#46;64-0&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;48 &#40;-0&#46;49-1&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Delta MELD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5 &#40;-2&#46;0-3&#46;0&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;2 &#40;-2&#46;7-11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Final Creatinine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1 &#40;1&#46;4-4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1 &#40;1&#46;4-4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Final MELD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;18-39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;21-40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Univariate comparison looking at Standard of Care &#40;albumin&#44; midodrine and octretotide&#41; compared to Pentoxyfylline &#43; Standard of Care&#46;</p>"
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      "titulo" => "References"
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          "identificador" => "bs0010"
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            0 => array:3 [
              "identificador" => "bib0005"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; predictive factors&#44; and prognosis of the hepatorenal syndrome in cirrhosis with ascites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Gin&#232;s A&#46;"
                            1 => "Escorsell A&#46;"
                            2 => "Gin&#232;s P&#46;"
                            3 => "Sal&#243; J&#46;"
                            4 => "Jim&#233;nez W&#46;"
                            5 => "Inglada L&#46;"
                            6 => "Navasa M&#46;"
                          ]
                        ]
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                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
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                        "volumen" => "105"
                        "paginaInicial" => "229"
                        "paginaFinal" => "236"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8514039"
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            1 => array:3 [
              "identificador" => "bib0010"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal failure in cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Gines P&#46;"
                            1 => "Schrier R&#46;W&#46;"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Eng J Med"
                        "fecha" => "2009"
                        "volumen" => "361"
                        "paginaInicial" => "1279"
                        "paginaFinal" => "1290"
                      ]
                    ]
                  ]
                ]
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            2 => array:3 [
              "identificador" => "bib0015"
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                  "contribucion" => array:1 [
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                      "titulo" => "Nitric oxide as a mediator of hemodynamic abnormalities and sodium and water retention in cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Martin P&#46;Y&#46;"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199808203390807"
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                        "tituloSerie" => "New Engl J Med"
                        "fecha" => "1998"
                        "volumen" => "339"
                        "paginaInicial" => "533"
                        "paginaFinal" => "541"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9709047"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Duhamel C&#44; Cervoni JP&#44; Icha&#239; P&#44; Abergel A&#44; et al&#46; Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome&#58; a retrospective multicenter study"
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                          "etal" => true
                          "autores" => array:3 [
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                      "titulo" => "Diagnosis&#44; prevention and treatment of hepatorenal syndrome in cirrhosis"
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                          "autores" => array:5 [
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                            3 => "Wong F&#46;"
                            4 => "Arroyo V&#46;"
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                        ]
                      ]
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                    0 => array:2 [
                      "doi" => "10.1136/gut.2006.107789"
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                      "titulo" => "A randomized&#44; prospective&#44; double-blind&#44; placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome"
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                          "etal" => true
                          "autores" => array:7 [
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                            3 => "Regenstein F&#46;"
                            4 => "Rossaro L&#46;"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2008.02.014"
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            6 => array:3 [
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                      "titulo" => "Noradrenaline vs&#46; terlipressin in the treatment of hepatorenal syndrome&#58; a randomized study"
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                          "autores" => array:7 [
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                            3 => "Kumar P&#46;"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jhep.2012.01.012"
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                            4 => "Lebrec D&#46;"
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                    0 => array:2 [
                      "titulo" => "Potential role of TNF alpha blockers in delaying the progression of hepato-renal syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Tahir F&#46;"
                            1 => "Riaz H&#46;"
                            2 => "Rehman A&#46;"
                            3 => "Munir M&#46;B&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mehy.2011.10.030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Medical Hypotheses"
                        "fecha" => "2012"
                        "volumen" => "78"
                        "paginaInicial" => "225"
                        "paginaFinal" => "226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22094211"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of pentoxifylline on survival&#44; cardiac function and both portal and systemic hemodynamics in advanced alcoholic cirrhosis-- a randomized double-blind placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Fern&#225;ndez-Rodr&#237;guez C&#46;M&#46;"
                            1 => "Lled&#243; J&#46;L&#46;"
                            2 => "L&#243;pez-Serrano P&#46;"
                            3 => "Guti&#233;rrez M&#46;A&#46;"
                            4 => "Marcos Alonso S&#46;"
                            5 => "P&#233;rez-Fern&#225;ndez M&#46;T&#46;"
                            6 => "F&#233;rn&#225;ndez Gil M&#46;A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Revista Espa&#241;ola de Enfermedades Digestivas&#58; &#211;rgano Oficial de la Sociedad Espa&#241;ola de Patolog&#237;a Digestiva"
                        "fecha" => "2008"
                        "volumen" => "100"
                        "paginaInicial" => "481"
                        "paginaFinal" => "489"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevention of hepatorenal syndrome in patients with cirrhosis and ascites&#58; a pilot randomized control trial between pentoxifylline and placebo"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Tyagi P&#46;"
                            1 => "Sharma P&#46;"
                            2 => "Sharma B&#46;C&#46;"
                            3 => "Puri A&#46;S&#46;"
                            4 => "Kumar A&#46;"
                            5 => "Sarin S&#46;K&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MEG.0b013e3283435d76"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Gastroenterol Hepatol"
                        "fecha" => "2011"
                        "volumen" => "23"
                        "paginaInicial" => "210"
                        "paginaFinal" => "217"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21285885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis&#58; a double-blind&#44; placebo-controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Akriviadis E&#46;"
                            1 => "Botla R&#46;"
                            2 => "Briggs W&#46;"
                            3 => "Han S&#46;"
                            4 => "Reynolds T&#46;"
                            5 => "Shakil O&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2000"
                        "volumen" => "119"
                        "paginaInicial" => "1637"
                        "paginaFinal" => "1648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11113085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pentoxifylline does not decrease short-term mortality but does reduce complications in patients with advanced cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Lebrec D&#46;"
                            1 => "Thabut D&#46;"
                            2 => "Oberti F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2010.01.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2010"
                        "volumen" => "138"
                        "paginaInicial" => "1755"
                        "paginaFinal" => "1762"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20102716"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Runyon B&#46;A&#46;"
                            1 => "Aasld"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hepatology &#40;Baltimore&#44; Md&#46;&#41;"
                        "fecha" => "2013"
                        "volumen" => "57"
                        "paginaInicial" => "1651"
                        "paginaFinal" => "1653"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vasoconstrictors in the treatment of hepatorenal syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Ortega R&#46;"
                            1 => "Calahorra B&#46;"
                            2 => "Gines P&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Nefrolog&#237;a"
                        "fecha" => "2002"
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                        "numero" => "Suppl&#46; 5"
                        "paginaInicial" => "56"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12107919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Terlipressin plus albumin infusion&#58; an effective and safe therapy of hepatorenal syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Uriz J&#46;"
                            1 => "Gin&#232;s P&#46;"
                            2 => "C&#225;rdenas A&#46;"
                            3 => "Sort P&#46;"
                            4 => "Jim&#233;nez W&#46;"
                            5 => "Salmer&#243;n J&#46;M&#46;"
                            6 => "Bataller R&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2000"
                        "volumen" => "33"
                        "paginaInicial" => "43"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10905585"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical course&#44; predictive factors and prognosis in patients with cirrhosis and type 1 hepatorenal syndrome treated with Terlipressin&#58; a retrospective analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Colle I&#46;"
                            1 => "Durand F&#46;"
                            2 => "Pessione F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastroenterol Hepatol"
                        "fecha" => "2002"
                        "volumen" => "17"
                        "paginaInicial" => "882"
                        "paginaFinal" => "888"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12164964"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A model to predict survival in patients with end-stage liver disease"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "Kamath P&#46;SI&#46;"
                            1 => "Wiesner R&#46;H&#46;"
                            2 => "Malinchoc M&#46;"
                            3 => "Kremers W&#46;"
                            4 => "Therneau T&#46;M&#46;"
                            5 => "Kosberg C&#46;L&#46;"
                            6 => "D&#8217;Amico G&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
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                        "tituloSerie" => "Hepatology"
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                        "volumen" => "33"
                        "paginaInicial" => "464"
                        "paginaFinal" => "470"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172350"
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                ]
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            ]
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ISSN: 16652681
Original language: English
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es en pt

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