[Therapeutic application of molecular adsorbent recirculation system in the treatment of multiple organ dysfunction syndrome patients].
OBJECTIVE
To assess the effectiveness of molecular adsorbent recirculation system (MARS) to remove nitric oxide(NO) and cytokines in multiple organ dysfunction syndrome(MODS) in patients with severe liver failure.


METHODS
Single MARS treatment were performed for 198 times with duration ranging from 6 to 24 hours on 61 MODS patients (42M/19F). The efficacy was evaluated by sequential organ failure assessment, biochemical parameters and the levels of pro-inflammatory cytokines.


RESULTS
The MARS therapy resulted in a significant removal of NO and certain cytokines such as tumor necrosis factor-alpha(TNF-alpha), interleukin-2(IL-2), IL-6, IL-8, and lipopolysaccharide-binding protein(LBP), together with marked reduction of other non-water soluble albumin bound toxins and water soluble toxins. These were associated with an improvement of the patients' clinical conditions, including deranged hemodynamics, respiratory function, cardiovascular and renal functions, hepatic encephalopathy, thus resulting in a marked decrease of sequential organ failure assessment(SOFA) score and improved outcome. Twenty-five patients were able to be discharged from the hospital, and successful liver transplantation could be performed in 6 patients. The overall survival rate of 61 patients was 41.0%.


CONCLUSIONS
MARS could be used for the treatment of MODS patients associated with elevated levels of NO and cytokines with satisfactory results.
Department of Infectious Diseases, the First People's Hospital of Foshan, Foshan 528000, Guangdong, China.
Hong-tao
HT
Luo
Li-min
LM
Guo
Quan-mei
QM
Liu
Min
M
Wu
Hong-lian
HL
Bai
Yue-hua
YH
Luo
Pei-hua
PH
Zhang
Zuan-di
ZD
Luo
Min-min
MM
Wang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006801:Humans; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000628:therapy*; D009569:Nitric Oxide / Q000378:metabolism; D016896:Treatment Outcome; D055815:Young Adult
D016207:Cytokines; D009569:Nitric Oxide