title: Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure.
abstract: OBJECTIVE
  Fractionated plasma separation and adsorption (FPSA) is an extracorporeal procedure that supports liver function by removing endogenous toxins that cause complications from acute-on-chronic liver failure (AOCLF). We performed a randomized trial to investigate survival of patients with AOCLF treated with FPSA.
  
  
  METHODS
  Patients with AOCLF were randomly assigned to groups given a combination of FPSA and standard medical therapy (SMT) (FPSA group, n = 77) or only SMT (SMT group, n = 68). The Prometheus liver support system was used to provide 8 to 11 rounds of FPSA (minimum of 4 hours each) for 3 weeks. Primary end points were survival probabilities at days 28 and 90, irrespective of liver transplantation.
  
  
  RESULTS
  Baseline clinical parameters and number of transplant patients were similar between study arms. Serum bilirubin level decreased significantly in the FPSA group but not in the SMT group. In an intention-to-treat analysis, the probabilities of survival on day 28 were 66% in the FPSA group and 63% in the SMT group (P = .70); on day 90, they were 47% and 38%, respectively (P = .35). Baseline factors independently associated with poor prognosis were high SOFA score, bleeding, female sex, spontaneous bacterial peritonitis, intermediate increases in serum creatinine concentration, and combination of alcoholic and viral etiology of liver disease. There were no differences between the 2 groups in the incidence of side effects.
  
  
  CONCLUSIONS
  Among all patients with AOCLF, extracorporeal liver support with FPSA does not increase the probability of survival. Further studies are needed to assess whether therapy might be beneficial in specific subsets of patients.
authors.affiliation: Department of Nephrology, University Duisburg-Essen, Essen, Germany. andreas.kribben@uni-due.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Kribben
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haag
authors.forename: Stefan
authors.initials: S
authors.lastname: Herget-Rosenthal
authors.forename: Ulrich
authors.initials: U
authors.lastname: Treichel
authors.forename: Christoph
authors.initials: C
authors.lastname: Betz
authors.forename: Christoph
authors.initials: C
authors.lastname: Sarrazin
authors.forename: Eric
authors.initials: E
authors.lastname: Hoste
authors.forename: Hans
authors.initials: H
authors.lastname: Van Vlierberghe
authors.forename: Angels
authors.initials: A
authors.lastname: Escorsell
authors.forename: Carsten
authors.initials: C
authors.lastname: Hafer
authors.forename: Oliver
authors.initials: O
authors.lastname: Schreiner
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.forename: Elena
authors.initials: E
authors.lastname: Mancini
authors.forename: Paolo
authors.initials: P
authors.lastname: Caraceni
authors.forename: Constantine J
authors.initials: CJ
authors.lastname: Karvellas
authors.forename: Hermann
authors.initials: H
authors.lastname: Salmhofer
authors.forename: Mladen
authors.initials: M
authors.lastname: Knotek
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
authors.forename: Justyna
authors.initials: J
authors.lastname: Kozik-Jaromin
authors.forename: Kinan
authors.initials: K
authors.lastname: Rifai
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005060:Europe; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016060:Sorption Detoxification / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001663:Bilirubin