Survival predictors in patients treated with a molecular adsorbent recirculating system.
OBJECTIVE
To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system (MARS).


METHODS
MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery, and as a bridge to liver transplantation (LTX). We analyzed the 1-year outcomes of 188 patients treated with MARS, from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic, clinical and laboratory parameters were recorded before and after each treatment. One-year survival and the number of LTXs were recorded. Logistic regression analysis was performed to determine factors predicting survival.


RESULTS
The study included 113 patients with acute liver failure (ALF), 62 with acute-on-chronic liver failure (AOCLF), 11 with graft failure (GF), and six with miscellaneous liver failure. LTX was performed for 29% of patients with ALF, 18% with AOCLF and 55% with GF. The overall 1-year survival rate was 74% for ALF, 27% for AOCLF, and 73% for GF. The poorest survival rate, 6%, was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis, whereas, patients with enlarged and steatotic liver had 55% survival. The etiology of liver failure was the most important predictor of survival (P < 0.0001). Other prognostic factors were encephalopathy (P = 0.001) in paracetamol-related ALF, coagulation factors (P = 0.049) and encephalopathy (P = 0.064) in non-paracetamol-related toxic ALF, and alanine aminotransferase (P = 0.013) and factor V levels (P = 0.022) in ALF of unknown etiology.


CONCLUSIONS
The etiology of liver disease was the most important prognostic factor. MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.
Kantola
Taru
T
Department of Anesthesiology and Intensive Care Medicine, Surgical Hospital of Helsinki, Helsinki University Central Hospital, HUCH, Helsinki, Finland. taru.kantola@hus.fi
Koivusalo
Anna Maria
AM
Parmanen
Satu
S
Höckerstedt
Krister
K
Isoniemi
Helena
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D017093:Liver Failure / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016060:Sorption Detoxification / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult