[Albumin dialysis in patients with acute exacerbation of chronic liver failure in an intensive care unit].
OBJECTIVE
To describe our experience with albumin dialysis (Molecular Adsorbent Recirculating System [MARS]) in patients who are in an intensive care unit due to an acute exacerbation of chronic liver failure.


METHODS
From January 2004 to October 2005 10 patients, aged 40 to 65 years (mean age 58.8), were admitted due to acute exacerbation of chronic liver failure. All of them suffered from an encephalopathy and were candidates for a liver transplantation. One to six MARS sessions were applied. Clinical parameters were registered before and after each session.


RESULTS
Of the 10 patients treated, 9 survived and 1 died. Five out of the 9 survivors were successfully transplanted. In 2 patients (one of them was the deceased one) the grade of encephalopathy was > I (II and III respectively), and in both improved to grade I. In the other ones, the encephalopathy did not worsen. The serum bilirubin diminished from 39.2 to 28.2 mg/dl (p < 0.01). In the 3 patients with serum creatinin > 1.5 mg/dl, this parameter diminished from 2.6 to 1.5 mg/dl (p < 0.01). Two patients had thrombocytopaenia and haemorrhage, and in one of them the MARS treatment had to be interrupted. No hypotension was observed.


CONCLUSIONS
The reduction in the serum bilirrubin and creatinin, as well as the clinical improvement of the two patients with encephalopathy grade > I, make us to think that the MARS can be useful to patients with acute exacerbation of a chronic liver failure as a bridge to a liver transplantation.
Moragues Ribes
Concepción
C
Servicio de Cuidados Intensivos, Hospital Universitario La Fe, Valencia, España. conchamoraguesribes@yahoo.es
Cases Viedma
Enrique
E
Ruano Marco
Miguel
M
D000328:Adult; D000418:Albumins; D003956:Dialysis; D005260:Female; D006501:Hepatic Encephalopathy / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016060:Sorption Detoxification; D016896:Treatment Outcome
D000418:Albumins