Effect of Midodrine on HVPG in Advanced Chronic Liver Disease
Condition: Chronic Liver Disease
MeSH terms: Liver Diseases
Study type: Interventional

Summary: 
      -  Primary objective: HVPG response after administration of midodrine as defined by
           decrease in HVPG by > 20 % from baseline or to less than equals to 12 mmHg.

        -  Secondary objectives: Change in HVPG, SVR, heart rate, cardiac output, cardiac index,
           Blood pressure (systolic, diastolic and mean).

      Methodology:

      Consecutive patients of chronic liver disease in the Institute (admitted or coming to OPD) as
      per the inclusion and exclusion criteria will be studied.

        -  Study Population: Patients of advanced chronic liver disease admitted or OPD patients in
           ILBS

        -  Study Design: A single arm interventional study

        -  Study Period: 6 months

        -  Inclusion Criteria: i) CLD with grade III ascites with Na < 130 / Systolic BP < 90 /
           type 2 HRS(n=30 ) (ii) ACLF (APASL criteria) with Na < 130 / Systolic BP < 90 / AKI
           (n=30)

        -  Exclusion Criteria: age < 18 and > 75, pregnancy, splanchnic venous thrombosis, HCC, HE,
           significant cardiopulmonary disease, uncontrolled diabetes, hypertension, intrinsic
           renal disease, peripheral vascular disease.

        -  Sample Size with justification: This is a pilot study where a total of 60 patients will
           be enrolled - 30 each in the two groups.

        -  Intervention: HVPG will be done in these patients at baseline and then after 3 hours of
           10 mg of midodrine tablets.

      Monitoring and assessment: Various parameters will be assessed during the procedure before
      and after 3 hours of midodrine such as HVPG (WHVP - FHVP), SVR, heart rate, cardiac output,
      cardiac index, Blood pressure (systolic, diastolic and mean), SpO2.

      - Statistical Analysis: Continuous data will be represented by mean ± SD or median ± IQR.
      Categorical data will be represented by n = frequency (%). Categorical data will be analyzed
      by Chi square test or Fisher exact test as appropriate. Continuous data will be compared by
      using student t test or Mann Whitney test (when applicable). The change in HVPG will be
      analyzed by using paired t test or Wilcoxon signed rank test. The % change in the individual
      group will be compared to see the significance between the groups. The significance will be
      seen at 5%.

        -  Adverse Effects: same as for HVPG (mild pain / hematoma at the puncture site, transient
           arrhythmias). Midodrine has got good safety profile and is used in patients of advanced
           chronic liver disease.

        -  Stopping Rule of study: nil

      Expected outcome of the project: If result shows that HVPG is decreased by midodrine, then it
      can be used in place of beta blockers when they are contraindicated or have the potential of
      causing adverse effects.
    


Intervention name(s): Midodrine Oral Tablet
Intervention type(s): Drug
Intervention description(s): Midodrine will be given 10 mg for one time only.
Intervention MeSH terms: Midodrine
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment