A case-control study of single-pass albumin dialysis for acetaminophen-induced acute liver failure.
BACKGROUND
Extracorporeal support with single-pass albumin dialysis (SPAD) may remove protein-bound toxins in acute liver failure. We evaluated the clinical, physiological and laboratory parameters of SPAD in acetaminophen-induced acute liver failure (AALF).


METHODS
Retrospective case-control studies of AALF patients were used.


RESULTS
We identified 13 AALF patients (6 SPAD-treated, 7 controls). The average age was 38 years, 92% were female, none had cirrhosis and the Model for End-Stage Liver Disease (MELD) scores were 43. Eleven patients (85%) fulfilled the King's College criteria for a liver transplant. SPAD-treated patients received 21 sessions (total: 147 h, mean 3.5 runs or 24.5 h/patient). There were no complications. No significant changes in clinical, physiological or biochemical parameters occurred during SPAD. Compared with the controls, there were no significant differences in ICU or 1-year survival, liver recovery or referral for a liver transplant.


CONCLUSIONS
SPAD was well-tolerated in AALF; however, it was not associated with differences in clinical outcomes. While SPAD may be an adjuvant supportive therapy in AALF, prospective trials are needed.
Karvellas
Constantine J
CJ
Division of Critical Care Medicine, University of Alberta, Edmonton, Alta, Canada.
Bagshaw
Sean M
SM
McDermid
Robert C
RC
Stollery
Daniel E
DE
Bain
Vincent G
VG
Gibney
R T Noel
RT
D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012709:Serum Albumin
D018712:Analgesics, Non-Narcotic; D012709:Serum Albumin; D000082:Acetaminophen