Plasma cytokine levels and coagulation and complement activation during use of the extracorporeal liver assist device in acute liver failure.
Multiple organ failure frequently occurs in patients with acute liver failure, and this has been associated with increased cytokine production. Treatment by hemoperfusion with an extracorporeal liver assist device (ELAD) containing human liver-derived cells was performed in 12 patients with acute liver failure. Over the first 6 h, there were significant increases in plasma tumor necrosis factor alpha (TNFalpha; from 114+/-54 pg/ml [mean+/-SEM] to 236+/-161 pg/ml, p < 0.05) and interleukin (IL)-6 (260+/-121 pg/ml to 445+/-149 pg/ml, p < 0.05) but not in interferon gamma (IFNgamma). A similar pattern with a small peak increase was observed for complement C5b-9 complex. Plasma C-reactive protein (CRP) and thrombin antithrombin (TAT) III complex showed small peaks after 24 h of ELAD hemoperfusion. No such changes were seen in 12 control patients with acute liver failure who were treated with intensive care alone. These transitory effects, without changes in blood pressure, are likely to be due to the contact of the blood with the dialyzer membrane. There was no evidence of the clearance of cytokines by the ELAD.
Hughes
R D
RD
Institute of Liver Studies, King's College School of Medicine and Dentistry, London, United Kingdom.
Nicolaou
N
N
Langley
P G
PG
Ellis
A J
AJ
Wendon
J A
JA
Williams
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D001777:Blood Coagulation / Q000502:physiology*; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis; D003167:Complement Activation / Q000502:physiology*; D015938:Complement Membrane Attack Complex / Q000032:analysis; D003422:Critical Care; D016207:Cytokines / Q000097:blood*; D005260:Female; D006464:Hemoperfusion / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D017114:Liver Failure, Acute / Q000503:physiopathology / Q000628:therapy*; D019164:Liver, Artificial; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology; D010447:Peptide Hydrolases / Q000032:analysis; D013499:Surface Properties; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015938:Complement Membrane Attack Complex; D016207:Cytokines; D015850:Interleukin-6; D008567:Membranes, Artificial; D014409:Tumor Necrosis Factor-alpha; C046193:antithrombin III-protease complex; D007371:Interferon-gamma; D000990:Antithrombin III; D002097:C-Reactive Protein; D010447:Peptide Hydrolases