MARS dialysis in decompensated alcoholic liver disease: a single-center experience.
Acute decompensation of chronically stable alcoholic liver disease (ALD) is the most common cause of terminal liver failure in developed countries. Molecular adsorbent recirculation system (MARS) is increasingly used as artificial liver support to facilitate spontaneous organ recovery. However, the experience to date and the evidence to justify this therapeutic strategy in acutely decompensated ALD are still insufficient. We report our clinical experience with MARS in 14 patients with acutely decompensated ALD (6 male subjects; median age [interquartile range], 51 [47-56] years; Child-Pugh score, 12 [10-13]; Acute Physiology and Chronic Health Evaluation (APACHE) II score, 20 [18-24]) and severely impaired liver function whose disease was unresponsive to conventional supportive care. At least 3 sessions were applied in any patient (48 sessions in total). Under MARS treatment, the following levels decreased: bilirubin (544 [489-604] to 242 [178-348] micromol/L; P<0.001), creatinine (212 [112-385] to 91 [66-210] micromol/L; P=0.002), cholestatic parameter gamma-glutamyl transpeptidase (5.9 [1.8-13.1] to 4.6 [1.8-8.3] micromol/L) (P<0.001), blood urea nitrogen (56 [32-91] to 34 [21-68] mmol/L; P=0.044), and platelet count (176 [85-241] to 84 [31-145] Gpt/L; P=0.004). In contrast, MARS failed to improve daily urine output (P=0.846), ammonia levels (P=0.340), or thromboplastin time (P=0.775). Only 3 patients survived the hospital stay (mortality 78.6%). Although MARS improved laboratory parameters of hepatic detoxification and renal function in patients with acutely decompensated ALD, the patients' mortality remained unsatisfactorily high. Our experience does not support the indiscriminative use of MARS in acutely decompensated ALD without further controlled studies.
Department of Internal Medicine, Intensive Care Division, HELIOS Kliniken Schwerin, Schwerin, Germany. bwolff@schwerin.helios-kliniken.de
Birger
B
Wolff
Klaus
K
Machill
Detlef
D
Schumacher
Ilona
I
Schulzki
D000641:Ammonia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D017093:Liver Failure / Q000401:mortality / Q000628:therapy*; D017114:Liver Failure, Acute / Q000097:blood / Q000628:therapy*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D016060:Sorption Detoxification / Q000379:methods*; D016896:Treatment Outcome
D000641:Ammonia; D001663:Bilirubin