Molecular Adsorbent Recirculating System Can Reduce Short-Term Mortality Among Patients With Acute-on-Chronic Liver Failure—A Retrospective Analysis
OBJECTIVES:Acute-on-chronic liver failure is associated with numerous consecutive organ failures and a high short-term mortality rate. Molecular adsorbent recirculating system therapy has demonstrated beneficial effects on the distinct symptoms, but the associated mortality data remain controversial...
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| Veröffentlicht in: | Critical care medicine 2017-10, Vol.45 (10), p.1616-1624 |
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| creator | Gerth, Hans U Pohlen, Michele Thölking, Gerold Pavenstädt, Hermann Brand, Marcus Hüsing-Kabar, Anna Wilms, Christian Maschmeier, Miriam Kabar, Iyad Torner, Josep Pavesi, Marco Arroyo, Vicente Banares, Rafael Schmidt, Hartmut H J |
| description | OBJECTIVES:Acute-on-chronic liver failure is associated with numerous consecutive organ failures and a high short-term mortality rate. Molecular adsorbent recirculating system therapy has demonstrated beneficial effects on the distinct symptoms, but the associated mortality data remain controversial.
DESIGN:Retrospective analysis of acute-on-chronic liver failure patients receiving either standard medical treatment or standard medical treatment and molecular adsorbent recirculating system. Secondary analysis of data from the prospective randomized Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial by applying the recently introduced Chronic Liver Failure-criteria.
SETTING:Medical Departments of University Hospital Muenster (Germany).
PATIENTS:This analysis was conducted in two parts. First, 101 patients with acute-on-chronic liver failure grades 1–3 and Chronic Liver Failure-C-Organ Failure liver subscore equals to 3 but stable pulmonary function were identified and received either standard medical treatment (standard medical treatment, n = 54) or standard medical treatment and molecular adsorbent recirculating system (n = 47) at the University Hospital Muenster. Second, the results of this retrospective analysis were tested against the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial.
INTERVENTIONS:Standard medical treatment and molecular adsorbent recirculating system.
MEASUREMENTS AND MAIN RESULTS:Additionally to improved laboratory variables (bilirubin and creatinine), the short-term mortality (up to day 14) of the molecular adsorbent recirculating system group was significantly reduced compared with standard medical treatment. A reduced 14-day mortality rate was observed in the molecular adsorbent recirculating system group (9.5% vs 50.0% with standard medical treatment; p = 0.004), especially in patients with multiple organ failure (acute-on-chronic liver failure grade 2–3). Concerning the affected organ system, this effect of molecular adsorbent recirculating system on mortality was particularly evident among patients with increased kidney, brain, or coagulation Chronic Liver Failure-C-Organ Failure subscores. Subsequent reanalysis of the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure dataset with adoption of the Chronic Liver Failure-cl |
| doi_str_mv | 10.1097/CCM.0000000000002562 |
| format | Article |
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DESIGN:Retrospective analysis of acute-on-chronic liver failure patients receiving either standard medical treatment or standard medical treatment and molecular adsorbent recirculating system. Secondary analysis of data from the prospective randomized Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial by applying the recently introduced Chronic Liver Failure-criteria.
SETTING:Medical Departments of University Hospital Muenster (Germany).
PATIENTS:This analysis was conducted in two parts. First, 101 patients with acute-on-chronic liver failure grades 1–3 and Chronic Liver Failure-C-Organ Failure liver subscore equals to 3 but stable pulmonary function were identified and received either standard medical treatment (standard medical treatment, n = 54) or standard medical treatment and molecular adsorbent recirculating system (n = 47) at the University Hospital Muenster. Second, the results of this retrospective analysis were tested against the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial.
INTERVENTIONS:Standard medical treatment and molecular adsorbent recirculating system.
MEASUREMENTS AND MAIN RESULTS:Additionally to improved laboratory variables (bilirubin and creatinine), the short-term mortality (up to day 14) of the molecular adsorbent recirculating system group was significantly reduced compared with standard medical treatment. A reduced 14-day mortality rate was observed in the molecular adsorbent recirculating system group (9.5% vs 50.0% with standard medical treatment; p = 0.004), especially in patients with multiple organ failure (acute-on-chronic liver failure grade 2–3). Concerning the affected organ system, this effect of molecular adsorbent recirculating system on mortality was particularly evident among patients with increased kidney, brain, or coagulation Chronic Liver Failure-C-Organ Failure subscores. Subsequent reanalysis of the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure dataset with adoption of the Chronic Liver Failure-classification resulted in similar findings.
CONCLUSIONS:Molecular adsorbent recirculating system treatment was associated with an improved short-term survival of patients with acute-on-chronic liver failure and multiple organ failure. Among these high-risk patients, molecular adsorbent recirculating system treatment might bridge to liver recovery or liver transplantation.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0000000000002562</identifier><identifier>PMID: 28640024</identifier><language>eng</language><publisher>United States: Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</publisher><subject>Acute-On-Chronic Liver Failure - classification ; Acute-On-Chronic Liver Failure - mortality ; Acute-On-Chronic Liver Failure - therapy ; Bilirubin - analysis ; Clinical Investigations ; Creatinine - analysis ; Female ; Humans ; Hyperbilirubinemia - therapy ; Male ; Middle Aged ; Organ Dysfunction Scores ; Randomized Controlled Trials as Topic ; Retrospective Studies ; Sorption Detoxification</subject><ispartof>Critical care medicine, 2017-10, Vol.45 (10), p.1616-1624</ispartof><rights>Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><rights>Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4572-6be52dafba3833e4b97bf88bcdb0ef408fbb803fa477663cc946810a01656d283</citedby><cites>FETCH-LOGICAL-c4572-6be52dafba3833e4b97bf88bcdb0ef408fbb803fa477663cc946810a01656d283</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28640024$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gerth, Hans U</creatorcontrib><creatorcontrib>Pohlen, Michele</creatorcontrib><creatorcontrib>Thölking, Gerold</creatorcontrib><creatorcontrib>Pavenstädt, Hermann</creatorcontrib><creatorcontrib>Brand, Marcus</creatorcontrib><creatorcontrib>Hüsing-Kabar, Anna</creatorcontrib><creatorcontrib>Wilms, Christian</creatorcontrib><creatorcontrib>Maschmeier, Miriam</creatorcontrib><creatorcontrib>Kabar, Iyad</creatorcontrib><creatorcontrib>Torner, Josep</creatorcontrib><creatorcontrib>Pavesi, Marco</creatorcontrib><creatorcontrib>Arroyo, Vicente</creatorcontrib><creatorcontrib>Banares, Rafael</creatorcontrib><creatorcontrib>Schmidt, Hartmut H J</creatorcontrib><title>Molecular Adsorbent Recirculating System Can Reduce Short-Term Mortality Among Patients With Acute-on-Chronic Liver Failure—A Retrospective Analysis</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVES:Acute-on-chronic liver failure is associated with numerous consecutive organ failures and a high short-term mortality rate. Molecular adsorbent recirculating system therapy has demonstrated beneficial effects on the distinct symptoms, but the associated mortality data remain controversial.
DESIGN:Retrospective analysis of acute-on-chronic liver failure patients receiving either standard medical treatment or standard medical treatment and molecular adsorbent recirculating system. Secondary analysis of data from the prospective randomized Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial by applying the recently introduced Chronic Liver Failure-criteria.
SETTING:Medical Departments of University Hospital Muenster (Germany).
PATIENTS:This analysis was conducted in two parts. First, 101 patients with acute-on-chronic liver failure grades 1–3 and Chronic Liver Failure-C-Organ Failure liver subscore equals to 3 but stable pulmonary function were identified and received either standard medical treatment (standard medical treatment, n = 54) or standard medical treatment and molecular adsorbent recirculating system (n = 47) at the University Hospital Muenster. Second, the results of this retrospective analysis were tested against the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial.
INTERVENTIONS:Standard medical treatment and molecular adsorbent recirculating system.
MEASUREMENTS AND MAIN RESULTS:Additionally to improved laboratory variables (bilirubin and creatinine), the short-term mortality (up to day 14) of the molecular adsorbent recirculating system group was significantly reduced compared with standard medical treatment. A reduced 14-day mortality rate was observed in the molecular adsorbent recirculating system group (9.5% vs 50.0% with standard medical treatment; p = 0.004), especially in patients with multiple organ failure (acute-on-chronic liver failure grade 2–3). Concerning the affected organ system, this effect of molecular adsorbent recirculating system on mortality was particularly evident among patients with increased kidney, brain, or coagulation Chronic Liver Failure-C-Organ Failure subscores. Subsequent reanalysis of the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure dataset with adoption of the Chronic Liver Failure-classification resulted in similar findings.
CONCLUSIONS:Molecular adsorbent recirculating system treatment was associated with an improved short-term survival of patients with acute-on-chronic liver failure and multiple organ failure. Among these high-risk patients, molecular adsorbent recirculating system treatment might bridge to liver recovery or liver transplantation.</description><subject>Acute-On-Chronic Liver Failure - classification</subject><subject>Acute-On-Chronic Liver Failure - mortality</subject><subject>Acute-On-Chronic Liver Failure - therapy</subject><subject>Bilirubin - analysis</subject><subject>Clinical Investigations</subject><subject>Creatinine - analysis</subject><subject>Female</subject><subject>Humans</subject><subject>Hyperbilirubinemia - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Organ Dysfunction Scores</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Retrospective Studies</subject><subject>Sorption Detoxification</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhS0EokPhDRDykk1aO3Z-vEGKohaQZgSirbq0HOemMTjxYDutZsdDIB6QJ6mrKVVhgTe2fM_57r06CL2m5IgSUR237eaIPDp5UeZP0IoWjGQkF-wpWhEiSMa4YAfoRQhfCaG8qNhzdJDXJU8OvkK_Ns6CXqzyuOmD8x3MEX8BbfzdZzTzFT7bhQgTbtWcCv2iAZ-NzsfsHPyEN-mlrIk73EwuiT8nT0IEfGniiBu9RMjcnLWjd7PReG2uweNTZezi4fePn01CRu_CFnRMJdzMyu6CCS_Rs0HZAK_u70N0cXpy3n7I1p_ef2ybdabTJnlWdlDkvRo6xWrGgHei6oa67nTfERg4qYeuqwkbFK-qsmRaC17WlChCy6Ls85odond77nbpJuh1Gt0rK7feTMrvpFNG_l2ZzSiv3LUsClELyhLg7T3Au-8LhCgnEzRYq2ZwS5BU0LyklWA8SfleqtPCwcPw0IYSeRepTJHKfyNNtjePR3ww_ckwCeq94MbZCD58s8sNeDmCsnH8P_sW5veyGQ</recordid><startdate>201710</startdate><enddate>201710</enddate><creator>Gerth, Hans U</creator><creator>Pohlen, Michele</creator><creator>Thölking, Gerold</creator><creator>Pavenstädt, Hermann</creator><creator>Brand, Marcus</creator><creator>Hüsing-Kabar, Anna</creator><creator>Wilms, Christian</creator><creator>Maschmeier, Miriam</creator><creator>Kabar, Iyad</creator><creator>Torner, Josep</creator><creator>Pavesi, Marco</creator><creator>Arroyo, Vicente</creator><creator>Banares, Rafael</creator><creator>Schmidt, Hartmut H J</creator><general>Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201710</creationdate><title>Molecular Adsorbent Recirculating System Can Reduce Short-Term Mortality Among Patients With Acute-on-Chronic Liver Failure—A Retrospective Analysis</title><author>Gerth, Hans U ; Pohlen, Michele ; Thölking, Gerold ; Pavenstädt, Hermann ; Brand, Marcus ; Hüsing-Kabar, Anna ; Wilms, Christian ; Maschmeier, Miriam ; Kabar, Iyad ; Torner, Josep ; Pavesi, Marco ; Arroyo, Vicente ; Banares, Rafael ; Schmidt, Hartmut H J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4572-6be52dafba3833e4b97bf88bcdb0ef408fbb803fa477663cc946810a01656d283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute-On-Chronic Liver Failure - classification</topic><topic>Acute-On-Chronic Liver Failure - mortality</topic><topic>Acute-On-Chronic Liver Failure - therapy</topic><topic>Bilirubin - analysis</topic><topic>Clinical Investigations</topic><topic>Creatinine - analysis</topic><topic>Female</topic><topic>Humans</topic><topic>Hyperbilirubinemia - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Organ Dysfunction Scores</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Retrospective Studies</topic><topic>Sorption Detoxification</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gerth, Hans U</creatorcontrib><creatorcontrib>Pohlen, Michele</creatorcontrib><creatorcontrib>Thölking, Gerold</creatorcontrib><creatorcontrib>Pavenstädt, Hermann</creatorcontrib><creatorcontrib>Brand, Marcus</creatorcontrib><creatorcontrib>Hüsing-Kabar, Anna</creatorcontrib><creatorcontrib>Wilms, Christian</creatorcontrib><creatorcontrib>Maschmeier, Miriam</creatorcontrib><creatorcontrib>Kabar, Iyad</creatorcontrib><creatorcontrib>Torner, Josep</creatorcontrib><creatorcontrib>Pavesi, Marco</creatorcontrib><creatorcontrib>Arroyo, Vicente</creatorcontrib><creatorcontrib>Banares, Rafael</creatorcontrib><creatorcontrib>Schmidt, Hartmut H J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gerth, Hans U</au><au>Pohlen, Michele</au><au>Thölking, Gerold</au><au>Pavenstädt, Hermann</au><au>Brand, Marcus</au><au>Hüsing-Kabar, Anna</au><au>Wilms, Christian</au><au>Maschmeier, Miriam</au><au>Kabar, Iyad</au><au>Torner, Josep</au><au>Pavesi, Marco</au><au>Arroyo, Vicente</au><au>Banares, Rafael</au><au>Schmidt, Hartmut H J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Molecular Adsorbent Recirculating System Can Reduce Short-Term Mortality Among Patients With Acute-on-Chronic Liver Failure—A Retrospective Analysis</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2017-10</date><risdate>2017</risdate><volume>45</volume><issue>10</issue><spage>1616</spage><epage>1624</epage><pages>1616-1624</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><abstract>OBJECTIVES:Acute-on-chronic liver failure is associated with numerous consecutive organ failures and a high short-term mortality rate. Molecular adsorbent recirculating system therapy has demonstrated beneficial effects on the distinct symptoms, but the associated mortality data remain controversial.
DESIGN:Retrospective analysis of acute-on-chronic liver failure patients receiving either standard medical treatment or standard medical treatment and molecular adsorbent recirculating system. Secondary analysis of data from the prospective randomized Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial by applying the recently introduced Chronic Liver Failure-criteria.
SETTING:Medical Departments of University Hospital Muenster (Germany).
PATIENTS:This analysis was conducted in two parts. First, 101 patients with acute-on-chronic liver failure grades 1–3 and Chronic Liver Failure-C-Organ Failure liver subscore equals to 3 but stable pulmonary function were identified and received either standard medical treatment (standard medical treatment, n = 54) or standard medical treatment and molecular adsorbent recirculating system (n = 47) at the University Hospital Muenster. Second, the results of this retrospective analysis were tested against the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure trial.
INTERVENTIONS:Standard medical treatment and molecular adsorbent recirculating system.
MEASUREMENTS AND MAIN RESULTS:Additionally to improved laboratory variables (bilirubin and creatinine), the short-term mortality (up to day 14) of the molecular adsorbent recirculating system group was significantly reduced compared with standard medical treatment. A reduced 14-day mortality rate was observed in the molecular adsorbent recirculating system group (9.5% vs 50.0% with standard medical treatment; p = 0.004), especially in patients with multiple organ failure (acute-on-chronic liver failure grade 2–3). Concerning the affected organ system, this effect of molecular adsorbent recirculating system on mortality was particularly evident among patients with increased kidney, brain, or coagulation Chronic Liver Failure-C-Organ Failure subscores. Subsequent reanalysis of the Recompensation of Exacerbated Liver Insufficiency with Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure dataset with adoption of the Chronic Liver Failure-classification resulted in similar findings.
CONCLUSIONS:Molecular adsorbent recirculating system treatment was associated with an improved short-term survival of patients with acute-on-chronic liver failure and multiple organ failure. Among these high-risk patients, molecular adsorbent recirculating system treatment might bridge to liver recovery or liver transplantation.</abstract><cop>United States</cop><pub>Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</pub><pmid>28640024</pmid><doi>10.1097/CCM.0000000000002562</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Critical care medicine, 2017-10, Vol.45 (10), p.1616-1624 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Acute-On-Chronic Liver Failure - classification Acute-On-Chronic Liver Failure - mortality Acute-On-Chronic Liver Failure - therapy Bilirubin - analysis Clinical Investigations Creatinine - analysis Female Humans Hyperbilirubinemia - therapy Male Middle Aged Organ Dysfunction Scores Randomized Controlled Trials as Topic Retrospective Studies Sorption Detoxification |
| title | Molecular Adsorbent Recirculating System Can Reduce Short-Term Mortality Among Patients With Acute-on-Chronic Liver Failure—A Retrospective Analysis |
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