| Predictive parameters after molecular absorbent recirculating system treatment integrated with model for end stage liver disease model in patients with acute-on-chronic liver failure. | |
| | |
MedLine Citation:
|
PMID: 20534256 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
AIM: The aim of study was to highlight parameters that in association with Model for End-stage Liver Disease (MELD) provide predictive criteria for long-term survival after treatment with the Molecular Adsorbent Recirculating System (MARS). Two homogenous groups were studied: one treated with standard medical therapy (SMT) and the other, with MARS. MATERIALS AND METHODS: Twenty acute-on-chronic liver failure patients on the waiting list for liver transplantation and affected by alcoholic cirrhosis with similar MELD scores (20-29) were evaluated for 7 days from inclusion and for 6-month survival. Ten patients (seven males and three females) were treated with MARS. Their mean age was 48.5 years (range = 35-61). The number of MARS applications was six for 6 consecutive days, and the length of the applications was 8 hours. Ten other patients (seven males and three females) were treated with SMT, including prophylaxis against bacterial infections and judicious use of diuretics. The precipitating factors were also treated appropriately. The mean age of the patients was 51 years (range = 37-64). All the variables that were significant upon univariate analysis were enrolled in a receiver operating characteristic analysis, with the intention to detect predictive parameters for patient death at 6 months. We considered a significant area under curve (AUC) value to be greater than 0.5. RESULTS: Among 11 patients who died within 6 months there were in the MARS group and eight in the SMT group: the 3- and 6-month patient survival rates were 90% and 70% versus 30% and 20% in the two groups, respectively. Nine measures resulted in an AUC > 0.5: DeltaMELD; interleukin (IL)-8; IL-6; tumor necrosis factor- alpha, MELD score; creatinine, bilirubin international normalized ratio (INR) and cardiac index. DeltaMELD and postoperative IL-8 concentrations showed better results (AUC = 0.899), followed by postoperative creatinine (AUC = 0.879), postoperative cardiac index (AUC = 0.833), and postoperative INR (AUC = 0.818). Postoperative creatinine showed the best sensitivity (100%), while IL-8, the best specificity (88.9%). CONCLUSION: A combination of biochemical and clinical variables probably represent the best way to predict the survival of patients, allowing physicians to select the best therapies for each patient. |
| | |
Authors:
|
G Novelli; M Rossi; G Ferretti; F Pugliese; D Travaglia; S Guidi; S Novelli; Q Lai; V Morabito; P B Berloco |
Related Documents
:
|
21413956 - Successful treatment of nocardia actinomycetoma with meropenem and amikacin combination... 21208666 - Hemangiomas of the nasal tip: an approach to a therapeutic challenge. 11449176 - Clinical significance of normobasemia in early post-operative outcome of hepatic resect... 20502896 - Effect of pancreaticoduodenectomy on the course of hepatic steatosis. 19967546 - Does an interspinous device (coflex) improve the outcome of decompressive surgery in lu... 16638496 - Rehabilitation following hip arthroscopy. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Transplantation proceedings Volume: 42 ISSN: 1873-2623 ISO Abbreviation: Transplant. Proc. Publication Date: 2010 May |
Date Detail:
|
Created Date: 2010-06-10 Completed Date: 2010-10-29 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0243532 Medline TA: Transplant Proc Country: United States |
Other Details:
|
Languages: eng Pagination: 1182-7 Citation Subset: IM |
Copyright Information:
|
Copyright (c) 2010 Elsevier Inc. All rights reserved. |
Affiliation:
|
Dipartimento P Stefanini Chirurgia Generale e Trapianti d'Organo, La Sapienza Università di Roma, Rome, Italy. novelligilnardo@virgilio.it |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adsorption Adult Chronic Disease Female Humans Liver Circulation* Liver Failure / complications*, mortality, pathology, surgery Liver Failure, Acute / complications*, mortality, pathology, surgery Liver Transplantation* / methods Male Middle Aged Predictive Value of Tests Survival Rate Survivors Waiting Lists |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Laparoscopic ultrasound-guided radiofrequency ablation as a bridge to liver transplantation for hepa...
Next Document: Pulmonary hypertension as a predictor of postoperative complications and mortality after liver trans...