Document Detail


Effects of fractionated plasma separation and adsorption on survival in patients with acute-on-chronic liver failure.
MedLine Citation:
PMID:  22248661     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: 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:
Andreas Kribben; Guido Gerken; Sebastian Haag; Stefan Herget-Rosenthal; Ulrich Treichel; Christoph Betz; Christoph Sarrazin; Eric Hoste; Hans Van Vlierberghe; Angels Escorsell; Carsten Hafer; Oliver Schreiner; Peter R Galle; Elena Mancini; Paolo Caraceni; Constantine J Karvellas; Hermann Salmhofer; Mladen Knotek; Pere Ginès; Justyna Kozik-Jaromin; Kinan Rifai;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-01-13
Journal Detail:
Title:  Gastroenterology     Volume:  142     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-06     Completed Date:  2012-05-31     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  782-789.e3     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Nephrology, University Duisburg-Essen, Essen, Germany. andreas.kribben@uni-due.de
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN50777531
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MeSH Terms
Descriptor/Qualifier:
Adult
Bilirubin / blood
Biological Markers / blood
End Stage Liver Disease / diagnosis,  mortality,  therapy*
Europe
Extracorporeal Circulation* / adverse effects,  mortality
Female
Humans
Kaplan-Meier Estimate
Liver Failure, Acute / diagnosis,  mortality,  therapy*
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Risk Assessment
Risk Factors
Sorption Detoxification* / adverse effects,  mortality
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Biological Markers; 635-65-4/Bilirubin
Investigator
Investigator/Affiliation:
Andreas Kribben / ; Guido Gerken / ; Sebastian Haag / ; Stefan Herget-Rosenthal / ; Ulrich Treichel / ; Christoph Betz / ; Christoph Sarrazin / ; Dominik Faust / ; Sabine Seeger / ; Dominik Bergis / ; Oliver Thorsten Ackermann / ; Helmut Geiger / ; Oliver Jung / ; Eric Hoste / ; Hans Van Vlierberghe / ; Jan De Waele / ; Carl Roosens / ; Sandra Oeyen / ; Kirsten Colpaert / ; Isabelle Colle / ; Anja Geerts / ; Stefaan Claus / ; Annemieke Dhondt / ; Johan Decruyenaere / ; Raymond Van Holder / ; Ángels Escorsell / ; Pere Ginès / ; Kinan Rifai / ; Carsten Hafer / ; Janet Cornberg / ; Michael P Manns / ; Oliver Schreiner / ; F Thieringer / ; S Gregor / ; G Stauffer / ; M Schuchmann / ; Peter R Galle / ; Antonio Santoro / ; Elena Mancini / ; Mauro Bernardi / ; Paolo Caraceni / ; Julia Wendon / ; Daniel Abeles / ; Constantine J Karvellas / ; Will Bernal / ; Hermann Salmhofer / ; Frieder Berr / ; Mladen Knotek /
Comments/Corrections
Comment In:
Med Klin Intensivmed Notfmed. 2013 Apr;108(3):181
Gastroenterology. 2012 Apr;142(4):690-2   [PMID:  22370211 ]

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