Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure.
OBJECTIVE
Acute liver failure (ALF) is a critical illness with high mortality. Plasma diafiltration (PDF) is a blood purification therapy that is useful for ALF patients, but it is difficult to use when those patients have multiple organ failure or unstable hemodynamics. In these patients, symptoms are also likely to exacerbate immediately after PDF therapy. We developed continuous PDF (CPDF) as a new concept in PDF therapy, and assessed its efficacy and safety in ALF patients.


METHODS
Ten ALF patients (gender: M/F 6/4, Age: 47 ± 14) were employed CPDF therapy. The primary outcomes were altered liver function, measured by the model for end-stage liver disease (MELD) score, and total bilirubin and prothrombin time international normalized ratios (PT-INR), 5 days after CPDF therapy. Secondary outcomes included sequential organ failure assessment (SOFA) scores, 5 days after CPDF therapy, and the survival rate 14 days after this therapy.


RESULTS
The MELD score (34.5-28.0; P = 0.005), total bilirubin (10.9-7.25 mg/dL; P = 0.048), PT-INR (1.89-1.31; P = 0.084), and SOFA score (10.0-7.5; P < 0.039) were improved 5 days after CPDF therapy. Nine patients were alive, and one patient died because of acute pancreatitis, complicated by ALF. There were no major adverse events related to this therapy under hemodynamic stability.


CONCLUSIONS
In the present study, CPDF therapy safely supported liver function and generally improved the condition of critically ill patients with ALF.
Intensive Care Unit, Kanazawa University Hospital, Kanazawa, Japan; Disease Control and Homeostasis, Kanazawa University, Kanazawa, Japan.
Takuya
T
Komura
Takumi
T
Taniguchi
Yoshio
Y
Sakai
Tatsuya
T
Yamashita
Eishiro
E
Mizukoshi
Toru
T
Noda
Masaki
M
Okajima
Shuichi
S
Kaneko
D000328:Adult; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006801:Humans; D019934:International Normalized Ratio; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time; D012449:Safety; D012720:Severity of Illness Index; D016896:Treatment Outcome
D015415:Biomarkers; D001663:Bilirubin
acute kidney disease; acute liver failure; blood purification therapy; plasma exchange