In this paper they explain in their results that they were unable to show a significant link between terlipressin and mortality, however, they were able to show a significant link between terlipressin and HRS reversal...But they also showed a significant link between HRS reversal and 180 day survival? How can increased 180 day survival not mean less mortality?
1 Answer
In the paper it says
Survival
Overall survival at day 180, as shown in Figure 3, was 42.9% (n = 24/56) vs 37.5% (n = 21/56) for terlipressin and placebo, respectively (P = .839).
That is a small 5% (n = 3/56) difference in survival rates.
Transplant-free survival up to day 180 also was similar in both groups. For patients who did not undergo liver transplantation, 7 patients (13%) in the terlipressin group and 5 patients (9%) in the placebo group survived to day 180. The causes of death for the 32 terlipressin patients and 35 placebo patients who died up to day 180 were hepatic failure/cirrhosis (15 terlipressin vs 15 placebo), HRS/renal failure (3 terlipressin vs 10 placebo), respiratory disorder (5 terlipressin vs 4 placebo), multiorgan failure (6 terlipressin vs 2 placebo), infections/systemic inflammatory response syndrome (SIRS) (7 terlipressin vs 2 placebo), gastrointestinal hemorrhage (0 terlipressin vs 3 placebo), cardiac event (0 terlipressin vs 2 placebo), and unspecified (1 in each group).
The key point which is also in the discussion section is that terlipressin does not affect the underlying liver disease and therefore transplant is still required for survival. Terlipressin extends life for a while for a small proportion of people but doesn't completely stop mortality.
Overall survival in both treatment groups was higher than in previously reported studies, primarily because of the fact that more than 30% of patients underwent liver transplantation. There were no significant differences in survival between those receiving terlipressin or placebo. As noted by previous investigators, terlipressin does not affect the underlying severe liver disease and therefore was not expected to have a major effect on survival.
answered Jun 21, 2018 at 7:50
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Thank you. That makes sense. So what they mean is that terlipressin doesn't extend life, technically (I assume mortality is a rigid term where terlipressin has to be the cause of survival), but it does so indirectly by extending life just long enough for a transplant? Are mortality and survival are different/independent terms in the literature?– PazeJun 21, 2018 at 8:25
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@Paze - They are independent terms but can have slightly different meanings depending on context. 180 day survival does not necessarily mean survival past 180 days. Plus as demonstrated, just because a medication helped to survive for 180 days, it doesn't mean the health concern will not be deadly. Jun 21, 2018 at 8:30