title: Hemodynamic changes during a single treatment with the molecular adsorbents recirculating system in patients with acute-on-chronic liver failure.
abstract: The aim of this pilot study is to evaluate the circulatory safety of treatment with the molecular adsorbents recirculating system (MARS) by determining the effect on systemic hemodynamics of a single MARS treatment in patients with acute-on-chronic liver failure (AOCLF). In eight patients admitted with AOCLF, a single 10-hour MARS treatment was performed. Systemic hemodynamic variables were determined before and during treatment. Bilirubin and urea were monitored as measures of protein-bound and water-soluble toxins. During MARS treatment, mean arterial pressure increased from 67 +/- 9 to 76 +/- 6 mm Hg (P < .05). Systemic vascular resistance index increased from 757 +/- 134 to 884 +/- 183 dyne x s/cm(5)/m(2) (P < .05), whereas cardiac index remained constant (5.9 +/- 0.7 v 6.0 +/- 1.1 L/min/m(2)). No episode of dialysis-induced hypotension was observed. Systemic oxygen consumption remained constant (92 +/- 30 v 93 +/- 11 mL/min/m(2)). Bilirubin levels decreased from 537 +/- 192 to 351 +/- 106 micromol/L (P < .05), and urea levels, from 19.1 +/- 13.9 to 6.7 +/- 5.1 mmol/L (P < .05). In conclusion, MARS treatment proved safe in critically ill patients with no attributing side effects.
authors.affiliation: Department of Hepatology, Rigshospitalet, University Hospital, Copenhagen, Denmark. lars.schmidt@dadlnet.dk
authors.forename: L E
authors.initials: LE
authors.lastname: Schmidt
authors.forename: V R
authors.initials: VR
authors.lastname: Sørensen
authors.forename: L B
authors.initials: LB
authors.lastname: Svendsen
authors.forename: B A
authors.initials: BA
authors.lastname: Hansen
authors.forename: F S
authors.initials: FS
authors.lastname: Larsen
mesh_terms: D000208:Acute Disease; D000328:Adult; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure; D002908:Chronic Disease; D005260:Female; D006439:Hemodynamics; D006801:Humans; D017093:Liver Failure / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D006435:Renal Dialysis / Q000379:methods*; D016060:Sorption Detoxification / Q000379:methods*; D014508:Urea / Q000097:blood; D014655:Vascular Resistance
chemical_list: D014508:Urea; D001663:Bilirubin